Preamble

The House met at half-past Nine o'clock

PRAYERS

[MADAM SPEAKER in the Chair]

Point of Order

Mr. Nick Gibb: On a point of order, Madam Speaker. Yesterday, the Postal Services Bill received its First Reading in this House. The Secretary of State for Trade and Industry has been all over the media this morning, debating and discussing the Bill with the country. However, I was not able to get a copy of the Bill from the Vote Office, and will not be able to get one until later this morning.
Given the Government's general contempt for the House and their obsession with the media, can it be right that the procedures of the House encourage such practices? Should we not change our procedures so that, when Bills receive their First Reading, hon. Members are able to get copies of them?

Madam Speaker: The hon. Gentleman is quite right. Our procedures have been such that, when a Bill receives its First Reading, it is not made available immediately. The hon. Gentleman may have a very good point to make, and perhaps he will take it up with the Procedure Committee. We talk about modernisation, and a modern practice such as the hon. Gentleman has described can be employed here.

BILL PRESENTED

SEXUAL OFFENCES (AMENDMENT)

Mr. Secretary Straw, supported by the Prime Minister, Mr. Secretary Blunkett, Mr. Secretary Milburn, Mr. Secretary Mandelson, Mr. Secretary Reid, Mr. Secretary Murphy and Mr. Paul Boateng, presented a Bill to reduce the age at which, and to make provision with respect to the circumstances in which, certain sexual acts are lawful; to make it an offence for a person aged 18 or over to engage in sexual activity with or directed towards a person under that age if he is in a position of trust in relation to that person; and for connected purposes: And the same was read the First time; and ordered to be read a Second time on Monday 31 January, and to be printed. Explanatory notes to be printed [Bill 55].

Medical Treatment (Prevention of Euthanasia) Bill

Order for Second Reading read.

Mrs. Ann Winterton: I beg to move, That the Bill be now read a Second time.
In previous years, I must admit that I have been one of the last to sign the book for the private Members' ballot. However, last year, quite by accident, I was in the No Lobby when I happened to see the Clerk with the ballot book. I said, "My goodness, you're not open for business yet, are you?", and he said, "Yes, I am." I saw that no one had signed the book, and we exchanged some banter about being able to sign No. 1, which I did. I did not appreciate that that number had as good a chance as any other, and in the event it emerged first when the ballot was held. So that is how winning the ballot is done.
It was a great surprise to me. After the initial excitement and euphoria died down, I had to deal with the mountain of post that all hon. Members who are successful in the ballot receive virtually automatically.
I gave the question of what should be the subject of my Bill a great deal of consideration. I came to the conclusion that I had chanced upon the one opportunity that a Member of Parliament gets to try to introduce to the House of Commons a measure that has very personal importance. I therefore chose this Bill, which deals with a subject on which I have campaigned for a number of years, to which I am committed and in which I believe, heart and soul. That is the way in which the Medical Treatment (Prevention of Euthanasia) Bill came to be born.
The purpose of the Bill is to call a halt to what has become the slide towards the acceptance and practice of euthanasia by making it clear to doctors that they cannot intentionally bring about the death of their patients, by action or by omission. Before I expand on the Bill, perhaps I should explain the context in which the need for it arises.
Food and fluid, administered by mouth or with the assistance of tubes, has always been regarded as a basic human right. Everyone is entitled to food and water, which are basic needs. However, for many years the international euthanasia bodies have promoted the idea of withdrawing assisted feeding from profoundly disabled people as a first step towards achieving euthanasia.
Another aim was to have living wills made legally binding, so that people could state in advance whether they wanted treatment in any given situation. I believe that that too was a first step towards people being allowed to say in advance whether they wanted a lethal injection if they became incapacitated.
In 1992, the British Medical Association produced a report in which the suggestion was made that assisted food and fluid amounted to treatment that could be withdrawn. The following year, assisted food and fluid was first legally defined as treatment by the Law Lords' decision in the case of the Airedale NHS trust against Mr. Anthony Bland. The BMA report was cited by some of the judges in justifying their decision.
The judgment caused such public concern that the House of Lords established the Select Committee on Medical Ethics to consider euthanasia and the treatment


of the sick and dying. Its unanimous report was published in 1994 and opposed euthanasia. It also opposed the concept that living wills could be legally binding, and it was against enshrining the Bland judgment in statute.
In addition to opposing the principle of doctors killing patients, the Committee was seriously perturbed about the obvious abuses that that could lead to, when old and vulnerable people might be pressured into agreeing to have their lives ended. We all know that elderly people do not wish to be a burden on their family or society.
There was disagreement on the Committee about the legal definition of assisted food and fluid as treatment. None the less, it recognised the dangers of having this enshrined in statute, thus allowing doctors to withdraw tubal feeding from patients who were not dying.
It had been made clear to the Select Committee by a number of organisations, including doctors involved in care for the dying, that the only reason for defining assisted food and fluid as treatment was to enable doctors to bring about the deaths of patients whose lives they considered should be ended. Shortly thereafter, however, the Law Commission report on mental incapacity was published in 1995. Although the law commissioners paid lip service to the House of Lords Committee, purporting to support its decisions against euthanasia, their report included a proposed Bill in which were clauses to make advance directives—living wills—legally binding. There was also a clause that would have enshrined the Bland judgment in statute.
The previous Government declined to introduce the proposed Law Commission Bill on mental incapacity, fearing that it would weaken our laws against euthanasia. In addition, both the previous Government and the present Government have cited the House of Lords Select Committee when voicing their opposition to euthanasia.
In December 1997, the Government published "Who Decides", a consultation document on care of the mentally incapacitated. This followed very closely the report of the Law Commission, and appeared to accept the concept of medical killing by the withdrawal of assisted food and fluid, thus causing death by starvation and dehydration. The document provoked a large and robust response, with more than 4,000 submissions. Indeed, it is the first time in more than 30 years that Churches of virtually every denomination, as well as the Muslim and orthodox Jewish communities, have united on a single issue.
The Government's response to the consultation, "Making Decisions", was published last October. The Government have subsequently made it clear that they have no intention of enshrining the Bland judgment in statute, and that they do not intend to take forward legislation to put advance directives on a statutory footing.
Since the Bland judgment, the British Medical Association has sought to widen the circumstances in which it is allowable to withdraw assisted food and fluid. In June 1999, the BMA produced guidance on withholding and withdrawing life-prolonging medical treatment. It included the recommendation that tubal feeding should be withdrawn on the agreement of only one independent doctor for a wide selection of people such as those who have had severe strokes or those with dementia.
The guidance states that its main focus is on
decisions to withdraw or withhold life-prolonging treatment from patients who are likely to live for weeks, months or possibly years if treatment is provided but who, without treatment, will or may die earlier. In some areas mention is also made of treatment decisions for those patients whose imminent death is inevitable".
This clearly indicates that the BMA intends the guidance to apply to those who are not dying as well as to those who are. That is of concern, because a recent statement published in the Voluntary Euthanasia Society of Scotland newsletter shows how, with the BMA's concurrence, we are sliding towards the practice of euthanasia. An article penned by Professor Sheila McLean, co-author of a draft assisted suicide Bill, as well as pro-euthanasia publications, tells us:
My suspicion is that the routes taken by courts have been tailored so they cannot be seen as endorsing voluntary euthanasia … Yet, arguably, the conclusion must be that the courts are endorsing a form of non-voluntary euthanasia …
That is significant because Professor McLean, an academic lawyer, was an important contributor to the British Medical Association guidelines on withholding and withdrawing life-prolonging medical treatment.
The BMA maintains that it is opposed to euthanasia and that its guidelines do not seek to extend any such practice. But as I have already said, its guidelines seek to widen the categories of cases from whom treatment, including assisted feeding, could be withdrawn, with the clear intention of ending the lives of patients who are not dying. In other words, the BMA guidelines extend the cases to whom they could apply what Professor McLean describes as "non-voluntary euthanasia". By contrast, the American Medical Association is actively opposed to any form of doctor-assisted dying, by either action or omission.
There has been much recent publicity about a number of cases throughout the United Kingdom in which it was alleged that many elderly patients were being denied appropriate medication and food and fluid in our hospitals. While the cases highlighted differed from those in which assisted food and fluid is deliberately withdrawn with the aim of ending the life of patients who are not dying, they reveal a growing lack of respect for and value of the aged and those with disabilities. I know that that is of great concern to many people in the country and in the House of Commons.

Mr. Quentin Davies: I congratulate my hon. Friend on introducing such an important measure this morning. Does she share my concern at growing anecdotal evidence that in the national health service people are being denied certain types of operation or other intervention simply on the grounds of age, and that de facto age discrimination is creeping into the NHS? Will she confirm that her Bill will outlaw that particularly pernicious form of age discrimination?

Mrs. Winterton: My Bill will not target specifically the matters that my hon. Friend raises. But I think that people on both sides of the House believe strongly that elderly people and those with disabilities should have the same opportunity for treatment as able-bodied and younger people. Such a state of affairs would receive universal approval. There is no doubt that there are growing stresses in the national health service. However, I do not believe, and I doubt whether anyone in the


Chamber does, that those who are less fortunate than ourselves should not receive the very best medical and nursing care.
Speaking about the recent cases highlighted by the media, one eminent physician, Dr. Adrian Treloar, said:
If the medical profession is going to move, as they have done, to a position where they accept the deliberate withdrawal of food and fluid from patients, then it's very difficult for patients to trust the doctors.
That is a very valid point.
It is against this background that I bring before the House for its consideration the Medical Treatment (Prevention of Euthanasia) Bill. It has been drafted in consultation with John Finnis, Professor of Law at Oxford university and Dr. John Keown, lecturer in medical law at Cambridge university, who are among the country's most eminent experts in law and medical ethics. Many other eminent doctors have also been consulted.
The Bill is short, clear and focused—something that, while difficult to draft, is essential to a private Member's Bill.

Sir Paul Beresford: I congratulate my hon. Friend on having produced an extremely simple Bill. I have an interest to declare—I am on the Board of Dental Protection, which is part of the Medical Protection Society Ltd, a large mutual society for doctors and professionals in the medical field. The society advises and assists doctors and medical professionals on legal matters. It has deep concerns as to the simplicity of the Bill and foresees the potential of double jeopardy for doctors. Will my hon. Friend meet representatives from the Medical Protection Society to discuss the introduction of some amendments that would allay their fears and concerns?

Mrs. Winterton: I am grateful for that intervention. As I continue my speech, I may be able to reassure my hon. Friend as to the Bill's provisions, and he will see why the measure is so simple, and why it is good to lay down a basic principle.
I realise that no Bill is perfect and that there are concerns about mine. I should be delighted to meet my hon. Friend's colleagues on the medical and dental organisations to which he referred to discuss their anxieties. I am sure that many such matters will be discussed in Committee. I hope that I have been able to reassure my hon. Friend.
The two experts and the other advisers who helped me to draft the Bill urged that it should pursue one simple objective: to restore the integrity of the fundamental principle of the law of murder. That is exactly what it does. The Bill concentrates on the purpose of the doctor in withdrawing or withholding medical treatment, or food and fluid, however delivered.
If the doctor's purpose is to end or shorten the life of the patient, then the withdrawal or withholding is unlawful homicide. That wording, specifically drafted by Professor Finnis and Dr. Keown, leaves undisturbed decisions to withdraw or withhold medical treatment, or food and fluid, where those decisions are made without purpose of causing the death of the patient, but rather because the treatment would not be of benefit to his or her health, or would be too burdensome for the patient.

Mr. Joe Ashton: The hon. Lady refers to murder. There appears to be no penalty in the Bill—for

example, whether the sentence should be life, 14 years or whatever. Is she aware that, in America, in similar circumstances, 85 cases have been brought to court, but none were successful? It was impossible to prove the case beyond reasonable doubt, which, as any lawyer knows, is essential in the prosecution of cases of murder or manslaughter.

Mrs. Winterton: The hon. Gentleman makes two points. The first is that there is no provision for sentence in the Bill. There does not have to be such a provision, because the measure merely plugs a loophole in the law that has existed since the early 1990s. No change is needed to the rest of that law.
The second point is that in America, where there is a different legal system, there have been no successful prosecutions. That is why the word "purpose" is used. That word is widespread in common law and is easily understood by professionals and by the general public. The hon. Gentleman makes a forceful point, but it would not apply to my Bill.

Mr. Crispin Blunt: As my hon. Friend points out, the word "purpose" is of key importance. Does she agree with Lord Brown-Wilkinson, whose judgment in the Bland case is central to the matter? He stated that the whole purpose of stopping artificial feeding was to bring about the death of Anthony Bland. If my hon. Friend's Bill had been law at that time, that would have been a case of murder, because the purpose was to bring Anthony Bland's life to an end.

Mrs. Winterton: That is an interesting observation. I should have thought that it was obvious to anyone in the House that, if it is the purpose of the doctor, in withdrawing medical treatment and food and fluids, no matter how delivered, to end the life of the patient, that is euthanasia. I suggest to my hon. Friend that the case he cites describes that situation.

Mr. Peter Bottomley: My hon. Friend has been most helpful to hon. Members and to those outside the Chamber by setting out plainly the general circumstances and the purpose of her Bill. She knows that she will receive my support on Second Reading. I think that she also knows that I do not want to reverse the Bland judgment, so she may find that, today, she has support from Members who differ from her over one part of the measure. I hope that she will take account of that point, as it may affect some of the debate on Third Reading.

Mrs. Winterton: I have heard my hon. Friend's comments; he has expressed that view to me privately. I understand where he is coming from.
The Bill deals with omissions—

Mr. Ashton: Will the hon. Lady give way?

Mrs. Winterton: I have already given way to the hon. Gentleman and answered the two points that he made. I shall make a little more progress before giving way again.
The Bill deals with omissions rather than positive actions, because the latter are already murder under existing law. There is no doubt about that. However,


the Bill leaves undisturbed the double effect principle, when a doctor adopts a course of treatment to ease a patient's pain or discomfort, but which may shorten the patient's life. The purpose of treatment in such a case is not to shorten the patient's life; it is to ease pain or discomfort.
The measure will bring to an end the efforts of the euthanasia lobby and of the BMA to widen the loophole created by the Bland judgment, which allowed doctors deliberately to end patients' lives, because those lives were thought to be of no value, rather than because the treatment was of no value. To tackle in one go all the issues relating to advance directives, or "living wills", is too great a task for a private Member's Bill. That is why the Bill does not do so.
Currently, there is much debate about the extent to which advance directives are legally binding. The Bill will not affect their legal status in any way, but a substantial vote in its favour will slow down the development of legally binding advance directives by sending a clear message that Parliament does not want the law to go further in that regard. The House would thus endorse the Government's decision not to proceed further with the development of advance directives.

Helen Jones: I am grateful to the hon. Lady for giving way. She knows that I have much sympathy with what she is trying to do. I am anxious about the problem of double effect. As the measure is drafted so as to rely on the doctor's purpose, that poses an evidential problem. It could put at risk doctors who have given a patient treatment which they know will both relieve suffering and hasten death. Will she expand on that point? As she will appreciate, it is difficult to prove purpose in a court.

Mrs. Winterton: I am grateful to the hon. Lady for making that point. I assure her that the Bill will not affect double effect, which is accepted medical practice at present. The best lawyers have assured me as to that. The measure will allow doctors to continue their present practice, as long as their purpose is to relieve pain and suffering. That would be obvious when a person is terminally ill; indeed, many of us have had experience of such cases. The measure would not prevent the doctor from giving the best possible treatment to his patient, even though the effect might be to shorten the patient's life. That is because the measure takes the common law definition of purpose, which is understood by everyone. The Bill will not change that in any way.

Several hon. Members: rose—

Mrs. Winterton: I will make a little more progress and then I will give way.
For all the reasons that I have given, the Bill has one simple focus—to try to restore the integrity of the fundamental principle of the law of murder and to make doctors responsible in law for their purposes in deciding on treatment of their patients. Several organisations have made misinformed comments about the Bill, so it might help the House if I made it clear what the Bill will not do.
First, the Bill will not require doctors to strive officiously to keep alive patients who are dying but, in accordance with good medical practice, they will need to ensure that appropriate care is given to such patients.
Secondly, the Bill will not prevent doctors from ceasing tubal feeding and hydration of patients where, for example, its provision has become too burdensome to the patient or where its continuation would not be of benefit to the health of the patient. However, the Bill will prevent them from ceasing tubal feeding for the purpose of killing patients.
Thirdly, the Bill will not prevent mentally competent adults from taking decisions relating to their own health care—for example, by refusing surgery, by refusing chemotherapy or by refusing blood transfusions.
Fourthly, to reinforce the point made by the hon. Member for Warrington, North (Helen Jones), the Bill will not prevent doctors from providing palliative care or other medical treatment for patients, provided such treatment is appropriate to their condition and necessary to reduce pain and discomfort, even if that has an unwelcome side effect of reducing life expectancy.

Dr. Jenny Tonge: I very much appreciate the hon. Lady's reference to doctors not striving officiously to keep alive. In my practice and in all our practice, we have always obeyed "thou shalt not kill", but we have also always obeyed
but needst not strive
officiously to keep alive".
The problem with the Bill is that it will cause us officiously to try to keep alive.

Mr. Deputy Speaker (Mr. Michael J. Martin): Order. I remind the hon. Lady that this is an intervention. She may wish to catch the Chair's eye later to put her case.

Mrs. Winterton: I reassure the hon. Member for Richmond Park (Dr. Tonge) that I am no vitalist who believes that we must deploy the full weight of medical science and technology to prolong life whatever the circumstances. On the contrary, I accept—

Dr. Tonge: The Bill forces doctors to strive "officiously to keep alive."

Mrs. Winterton: No, it does not.
I accept that death is the inevitable conclusion of life—indeed, to some of us, its culmination. It is an event for which we should prepare and to which we should move forward with confidence and security, not with fear of our own doctors and their motives.

Ms Julia Drown: rose—

Dr. Evan Harris: rose—

Mrs. Winterton: I give way to the hon. Member for South Swindon (Ms Drown).

Ms Drown: The hon. Lady says that she does not want to make treatment too burdensome for patients and that that is allowed for in the Bill, so that a kidney dialysis patient who is deteriorating and says, "I want to die"


would be allowed to have their treatment withdrawn; but the Bill just says that a doctor cannot "withdraw … treatment … if" the "purpose" of so doing
is to hasten … the death of the patient.
Could she clarify that?

Mrs. Winterton: I could indeed. The hon. Lady is muddling up two completely different things. First and foremost, every mentally competent patient can refuse treatment, as I said. There is no need for the Bill to say that because the Bill does not change the present law in any way. Therefore, a patient can refuse to have treatment. The rather stupid example cited by the BMA does not hold water because someone who is on kidney dialysis and then has cancer that is terminal can refuse to be on dialysis. His doctor would of course explain the consequences of that, but the patient who has made up his mind can refuse treatment. If the doctor tried to give dialysis or any other treatment against the wishes of a mentally competent patient, that would be assault; the present law makes that absolutely clear.

Dr. Peter Brand: Will the hon. Lady give way?

Mrs. Winterton: No, I will not give way. I have answered the point as clearly and forcefully as I can.

Ms Drown: Will the hon. Lady give way?

Mrs. Winterton: I shall give way once more, but then I intend to proceed.

Ms Drown: I am grateful for that explanation. If, in a similar set of circumstances, a patient wanted to have food or fluid withdrawn, would the same argument apply?

Mrs. Winterton: If the patient was mentally competent, one would try the purpose test, and if the patient was mentally competent, the law would be as it is now—that a patient can refuse anything. My Bill does not alter that in any way.

Dr. Harris: rose—

Mrs. Winterton: I intend to make progress, because I realise that many hon. Members on both sides of the argument and both sides of the House wish to contribute.
Last week, I met representatives of the BMA medical ethics committee, including its chairman, Dr. Michael Wilks. Despite my best efforts to allay their fears, Dr. Ian Bogle, chairman of the council of the BMA, has subsequently written to many hon. Members opposing my Bill. However, I must tell the House that their arguments are flawed. Their letter has entirely mistaken the legal effect of the Bill.
Dr. Bogle says that the Bill would "diminish consideration" of the patient's best interests—including values, beliefs, views, and desires about degree and type of medical treatment—and would "make worthless" a patient's valid refusal of treatment
by restricting the law to have regard only for 'the purpose or one of his purposes' of the doctor (Clause 1)".

That is utterly mistaken, as I have just tried to tell the hon. Member for South Swindon. The Bill would in no way diminish the law's requirement and the doctor's responsibility and right to take into account the best interests, values, beliefs, views and desires of patients. The Bill would do nothing except prohibit the doctor from pursuing a purpose of killing or hastening the death of the patient by withdrawing or withholding treatment.
The law has always forbidden doctors to give medicines with a purpose of killing or hastening death. That prohibition in no way diminishes the doctor's duty and right to take into account the patient's best interests, beliefs and so on when deciding whether to give treatment and what treatment to give.
Under the ruling of a majority of the Law Lords in Bland—a ruling unnecessary to the decision in that case—it was equally clear that no one responsible for a patient could withhold or withdraw treatment, care or sustenance with a purpose of killing or hastening death. That prohibition, too, in no way diminished the doctor's duty to take into account the patient's best interests and so on when deciding whether to withhold or withdraw treatment. The Bill would do nothing but restore that legal prohibition.
Dr. Bogle's two scenarios are also entirely erroneous. As I have said, the Bill would certainly not have the legal effect of preventing a doctor from withdrawing dialysis at the request of a patient, nor would a doctor whose purpose in withdrawing treatment for cancer was to follow the patient's informed and expressed view be regarded as having the purpose of bringing about the patient's death. As I said, a doctor whose reason for withholding or withdrawing treatment is to respect the valid wishes indicated by a competent patient, is doing so for that purpose and not for the purpose of killing or hastening death. The same is true of a doctor who decides to withdraw or withhold treatment on the ground that it is medically futile or too burdensome to the patient.
No doctor need fear that the Bill would affect any part of their existing legal and ethical responsibility and opportunity to take full account of the patient's best interests, beliefs, wishes and so on. The Suicide Act 1961 already forbids doctors to assist in suicide. The only doctors who would be affected by the Bill are those who, being responsible for a patient too ill to take his or her own decisions, set out precisely to try to shorten such a patient's life by a course of omissions adopted for that purpose.

Dr. Harris: Will the hon. Lady give way?

Mrs. Winterton: I will not; I intend to continue my speech because I have given way so many times already. I hope that the hon. Gentleman will have an opportunity to speak, and, if he catches your eye, Mr. Deputy Speaker, I am sure that he will do so.
Dr. Bogle's claim that the Bill is simplistic and would complicate and hinder the practice of medicine is like saying that the law prohibiting insider dealing is simplistic and hinders investment fund management. Like that law, the Bill would clarify the situation. It would also alleviate well-founded fears of victimisation, free up doctors to use their professional skills to the full and restore a boundary line essential to patients' confidence and trust in their doctors.
The BMA's hasty interpretation of the Bill is completely wrong. My Bill is totally in line with the law and with medical ethics as generally understood and accepted until 1993—and still very widely accepted indeed. It is unlawful and unethical purposefully to hasten death by an act. The Bill would simply return coherence to law and medical ethics by restoring the law's prohibition on the purposeful hastening of death by omission.
Since I announced my Bill in December, I have received a great number of letters and messages of support from a wide variety of sources. Many individuals and doctors have contacted me to tell of their own experiences. I have received messages of support from many leaders of the various Christian denominations, including bishops and archbishops of both the Anglican and the Catholic Churches. In addition, I have received the backing of the Chief Rabbi, Dr. Sacks, as well as of a number of prominent leaders among the Muslim community.
My Bill not only conforms with the European convention on human rights, but positively seeks to entrench its most fundamental right—that of right to life itself. The Bill specifically conforms to article 2 of the convention, which states that
no one shall be deprived of his life intentionally".
The Bill also promotes the principles adopted by the Parliamentary Assembly of the Council of Europe in its report on the "Protection of Human Rights and the Dignity of the Terminally Ill and the Dying", which states:
The Assembly … recommends that the Committee of Ministers encourage the member states of the Council of Europe to respect and protect the dignity of terminally ill or dying persons in all respects by upholding the prohibition against intentionally taking the life of terminally ill or dying persons".
In giving its support to my Bill, the House would give a clear signal that it supports Hippocratic medicine. It would also continue to send the message that it is opposed to euthanasia either by action or omission. In December 1997, the hon. Member for Bassetlaw (Mr. Ashton) sought to introduce the Doctor Assisted Dying Bill under the ten-minute rule. On that occasion, the House gave its resounding view that such a Bill was not one it wished to see introduced and refused to give leave for the Bill to be introduced, by 234 votes to 89. The House should maintain the course that it set that day by endorsing my private Member's Bill.
There is a need for the House to send a clear and unequivocal message to the vulnerable, the elderly, the disabled and the terminally ill that they are still valued members of our society. Equally, I believe that it is imperative that we send a message to the doctors and health care workers of this country. That message is that their hard work and dedication to the health of their patients must not be undermined by accepting an ethos, promoted by only a few in their profession, that some lives are less worthy than others and should be brought to an end.
The Bill is short and simple and I shall not claim that it is perfect, but it is a genuine attempt to address a very real problem. Members have intervened on a number of occasions to raise concerns. When those concerns are

legitimate, I assure the House that we shall return to them again in Committee. Bearing that in mind, I ask the House to give the Bill a Second Reading and allow it to proceed to Committee, where such points can be considered. I commend the Bill to the House.

Mr. Jim Dobbin: I congratulate the hon. Member for Congleton (Mrs. Winterton) on coming first in the ballot for private Members' Bills. She has told us how she manipulated that, which was very interesting. I also congratulate her on choosing what I know is a very sensitive but important issue for the House and the whole country. The Bill would go a long way to alleviate some of the unease experienced by elderly and vulnerable patients in hospital.
As the hon. Lady said, statute law is becoming confused by recent developments in the courts and there is a need to prevent the principles applied in the Bland case from being extended to patients with other conditions. An increase in the number of patients dying from lack of food and fluid will increase calls for euthanasia. In 1984, Dr. Helga Kuhse, a leading campaigner for euthanasia, said:
If we can get people to accept the removal of all treatment and care, especially the removal of food and fluids, they will see what a painful way this is to die and then, in the patient's best interest, they will accept the lethal injection.
The elderly and the disabled are the weakest and most vulnerable in our society and they deserve to be protected. They are not always able to express their views and they need a voice to speak on their behalf. The law, at present, is open to abuse and at times it seems, by withholding or withdrawing food and fluid, euthanasia may already be taking place.
Hydration and nutrition are basic human rights and should never be regarded as treatment, and I would like to describe two cases to substantiate my view. An elderly constituent of 92 was admitted to hospital after breaking her femur. She made a fairly good recovery and was transferred to another hospital for physiotherapy and other appropriate rehabilitation.
In the second hospital, the family visitors were requested to avoid meal-times and to visit in the evenings. It soon became apparent to the family that the patient's condition was deteriorating. Her lips were dry, she appeared to be asleep or very lethargic at visiting times, she had developed a bad cough and her colour was poor. The family became alarmed and, when they could not rouse the patient, they asked if she had had anything to eat or drink. They were told that the patient did not want anything to eat and that they could not force feed her. No monitoring of food and fluid intake had taken place.
Fortunately for that lady, her family were determined. They were able and willing to demand that care, treatment and rehabilitation took place and they insisted that their mother be given the treatment, which was the physiotherapy, and the care, which was the food and the fluid, that she needed and deserved.
Several months later, the lady is back home, walking and eating well, and she has made a successful recovery. The family are, of course, happy at the outcome, but dissatisfied with the initial lack of food and fluid and treatment in the second hospital. Therefore, I am pursuing that case with the trust concerned.
Should food and fluid be regarded as treatment or as a basic human right? Without food and fluid, the lady would have died. She is now at home with her family around her, is enjoying life and has regained her mobility.

Dr. Harris: Does the hon. Gentleman accept that there is no disagreement that normally given food and fluids are basic care and should never be withdrawn? The argument—and there is an argument—is about artificial feeding through intravenous lines or gastrotomy tubes placed during an operation under general anaesthetic and not about the basic food and care that is fundamental to good medical and social care.

Mr. Dobbin: I accept that, but I suggest that there is now an increasing number of cases where what I describe occurs. There have been several such cases in my constituency.
The second example is that of my own grandson, who was born with an extremely rare congenital neuromuscular disorder, one of the effects of which is that he has great difficulty swallowing. His condition was not diagnosed until more than 10 weeks after his birth; in the intervening period, he lost weight continually. He was tube fed: that feeding was not treatment, but basic care, given to keep him alive until diagnosis could be made. With the help of a drug, taken every three hours for the rest of his life, my grandson can swallow and so eat and drink normally.
Both the cases I have describe prove that food and fluid, however administered, should not be classified as medical treatment. All people, sick and healthy, need food and fluid to live. There have been recent reports of elderly patients being deprived of food and fluid, and I understand that the Crown Prosecution Service is reviewing several such cases. Certain cases in the United Kingdom courts have made the current law unclear, and the Bill would clarify that law.

Dr. Tonge: Does the hon. Gentleman really believe that the sometimes extremely painful and distressing insertion of a nasal tube leading to the stomach, or an operation for a gastrotomy, which puts food directly into the stomach, do not constitute medical treatment? He has just said that the provision of any food or fluid is not medical treatment.

Mr. Dobbin: In my view, the feeding process is not treatment, but constitutes care to keep the patient alive.
The BMA recognises the difficulty arising from the blurring of the law and has issued guidelines to doctors. Unfortunately, those guidelines recommend the principle of withholding food and fluid from patients who are likely to live for weeks, months or possibly years if treatment is provided, but who without treatment will or may die sooner. That adds up to a deliberate decision to dehydrate someone who is not dying. The guidelines recommend that the withdrawal of tubal feeding should be allowed for a range of patients, including those who have suffered severe strokes and seriously handicapped newborns, on the agreement of one doctor only; there is no need to apply to the court. Far from clarifying the position, that recommendation confuses it still further.
In the cases I have described—I could have added others—it is obvious that the BMA guidelines could have resulted in wrong decisions being made by medical teams.

Since when have we given doctors and medical staff the duty of deciding whose life is not worth living? We expect doctors to cure us and, if that is not possible, we expect good care and relief of suffering. Hon. Members should ask themselves these questions: if they were taken to hospital and found that they were unable to communicate, would they feel confident that they would be given every care and treatment necessary, or would they worry that their death would be hastened or brought about by dehydration?
The BMA guidelines do nothing to alleviate such fears, which have been experienced by many of my constituents and clearly expressed in many letters that I have received on the subject. The BMA is understandably anxious to protect its members and ensure that no doctor is criticised for decisions about the care of patients. We accept that. However, it is astonishing that the BMA does not support the Bill and that its reasons for not doing so take no account of the clear wording of and intention behind this very simple Bill.
The Bill is not designed with the aim of keeping patients alive at all costs. Nothing in it suggests that treatment, hydration or nutrition should be forced on a patient who is in the process of dying or in cases where the placement of tubes would be regarded as intrusive, inappropriate or engendering excessive risk. The Bill would merely make it an offence to withdraw or withhold medical treatment or food and fluid if the purpose of so doing is to hasten or otherwise cause the death of the patient. Nothing could be clearer.

Mr. Ashton: Does my hon. Friend accept that the BMA states as a condition for doctors that
both legally and ethically, all treatment decisions must promote the patient's 'best interest'"?
If the BMA guidelines are rejected, who is to promote the patient's best interest if the patient is unconscious?

Mr. Dobbin: I accept my hon. Friend's point, but I believe that the BMA guidelines are unclear, both to doctors and to the public.
The Bill would protect vulnerable citizens from becoming the subject of direct killing by making it clear that a doctor cannot act with the purpose of deliberately ending human life. In a letter sent to Members of Parliament, the BMA has put an extraordinary interpretation on the Bill. It cites the example of a patient with long-standing but progressive cancer who may wish to state in advance what treatment should be given, withheld or withdrawn in the event of the cancer spreading and the patient becoming unable to express a view. The BMA claims that to follow the patient's informed and expressed view would be open to interpretation as having the purpose of bringing about the patient's death.
That is incorrect, as the BMA acknowledges in its own guidelines, which state that, although a health care team may foresee that withholding or withdrawing life-prolonging treatment will result in the patient's death, that is fundamentally different from action taken with the purpose or objective of ending the patient's life. It appears that the BMA is confused and requires the guidance of the law to protect its members' interests. The medical


profession is split on the BMA guidelines, believing that the guidelines are open to different interpretations and that they will cause unnecessary confusion.

Mr. Blunt: The hon. Gentleman says that the BMA guidelines are confused, but I remain confused about the hon. Gentleman's views on the basic issue of whether or not artificial feeding and hydration is treatment. In response to interventions, he implies that it is not treatment and should not be regarded as such, but he then states that it is treatment when describing the circumstances in which one might be regarded as seeking officiously to sustain life. What is his conclusion on whether artificial feeding and hydration can be described as treatment?

Mr. Dobbin: My view is simply that providing food and fluid constitutes care of the patient.
The difference of opinion within the medical profession was made clear in a letter sent to all Members of Parliament by John Finnis, professor of law at Oxford university, John Keown, lecturer in medical law at Cambridge university and Lord McColl of Dulwich, professor of surgery at Guy's hospital. The hon. Member for Congleton has already quoted the letter, but it is worth repeating one sentence:
This Bill is totally in line with the law and medical ethics as generally understood and accepted until 1993, and still very widely accepted.
That provides important clarification. In addition, not all members of the BMA medical ethics committee, which published the guidelines, were in agreement on the final version. To allow the current position to persist leaves a loophole that opens the way to euthanasia. I urge the House to support the Bill.

Dr. Peter Brand: I congratulate the hon. Member for Congleton (Mrs. Winterton), not only on coming top of the ballot but on her choice of the subject of her Bill and, indeed, its title. For some weeks prior to its publication, I was in some difficulty as to the reply I should send to the many constituents and organisations that wrote to me about it.
There is no doubt that the practice of medicine is changing, as is the way in which people interact with medical services. The traditional pattern of people knowing their avuncular, paternalistic local GP for 10, 20 or 30 years is fast disappearing. I have been privileged to spend the past 20-odd years practising in the same village, caring for the same population, but that is no longer the norm in much of our country.
If the Prime Minister is to be believed, we shall from now on gain access to the national health service through the telephone lines of NHS Direct or through polyclinics with a duty doctor or nurse. The hospital sector will be far more "industrialised", with people being rushed through. Standards of nursing care remain technically good, but are sometimes lacking in the care aspects because of the sheer pressure of work that hospital workers experience. I understand why the hon. Member for Congleton has picked this important issue. Many people are uncertain as to what the practice is now and what it should be. Clearly it is a matter that should be debated.
There has been some discussion this morning on what constitutes treatment and what constitutes care. I take the view that that does not matter one little bit. In my view, whatever makes people feel well, even if it does not necessarily make them feel better, is treatment. Having a care assistant sitting beside a bed holding someone's hand when they are confused is treatment. I see little point in pursuing the argument about feeding through a gastrotomy tube or a nasogastric tube, or through a spoon or dribbling cup, because I am not sure whether it makes any difference. The essential difference is the stress that the process causes to patients.
Where I part company with the hon. Member for Congleton is when she draws a parallel between acts of omission and acts of commission. I find that extremely difficult. We have all been bombarded with bits of paper from various organisations, some very reasonable and some entirely extraordinary. I have received a very good leaflet from Right to Life. It is a well-argued set of paragraphs. However, the people who call themselves Right to Life seem to forget that there is a parallel to the right to life, and that is the right to death. We sometimes forget that people are entitled also to slip away and to leave this life in a quiet, peaceful manner. If the Bill had been an Act and part of the law when I qualified as a doctor in 1971, I think that I would now be a multi-murderer. Medical killing is equal to murder. The withdrawing of treatment or not instituting treatment, knowing that that will hasten or even cause death, would be murder.
It is a curious thing—

Mr. Kevin McNamara: The hon. Gentleman is making an important point that needs to be clarified. Is he saying that his purpose in withdrawing treatment was to hasten or otherwise cause the death of a patient? That is the nub of it.

Dr. Brand: That is an extremely good question. I think that the answer is that I allowed death to occur. That is the nub of the argument. To assume that medical intervention can guarantee life or death is nonsense. That assumes that doctors have powers that they do not possess. It assumes powers of prognostication that doctors do not have. I do not know which of the Members now in the Chamber will drop dead tomorrow, next week or during the next 10 years. I cannot tell.

Mr. Nicholas Winterton: Neither can they.

Dr. Brand: Quite.
I may be faced with an elderly lady who I know has been very unhappy over the past five years, who has been increasingly confused and who is finding life a real burden. If that lady develops bronchopneumonia and I know that she does not want any further treatment because we have talked about the matter, and I withhold antibiotics, I might have made an assumption that if I treated that bronchopneumonia that lady would get better and might carry on for another five years. On the other


hand, I know that there is a greater likelihood if I withhold the antibiotics that she will die, probably in the next few days, quietly slipping away.

Mr. Winterton: I am following the hon. Gentleman's argument closely. I respect him because he is a qualified doctor.

Dr. Brand: That is no reason to respect me.

Mr. Nicholas Winterton: I think that people instinctively respect the medical profession, and I want that respect to continue. The hon. Gentleman is talking about treatment, but in the example that he has given, would he withdraw food and hydration? I think that that is an important question. Will he answer it?

Dr. Brand: That is a good point. There is a distinct difference between medical interventions in the sense of giving antibiotics, performing operations, putting people on a heart-lung machine, putting up drips and all that sort of paraphernalia, and basic care—for example, keeping people warm, keeping them supported and making sure that, even if they are not conscious, there is someone sitting with them.
When I used to train general practitioners, they were always astonished when I said, "One of the most satisfying things as a general practitioner is to have been involved with a good death." We all become excited about curing people and delivering babies, for example, and that is all splendid. However, there is something intensely satisfying when at the end of the day someone passes away quietly and in dignity while supported by his family. That person feels that he has not upset other people and the people concerned are not upset. The whole process is a happy one. That might seem bizarre.
That sort of death with dignity involves the support of others. There should be good nursing so that people do not have dried, cracked lips. They should have regular mouth washes and lip salves should be applied. They should not be allowed to develop bed sores. That is good basic nursing and care.
I would differ slightly from the hon. Member for Macclesfield (Mr. Winterton) if that good basic nursing and care involves struggling with and half drowning people to get water into them, by placing tubes down their gullets when they do not want that to happen. That is not basic sense.

Mr. Winterton: That is not what the Bill says.

Dr. Brand: With all due respect, to take up that sedentary interjection, the Bill is not clear. The Bill provides that there shall be no omission that will knowingly hasten death.

Dr. Tonge: May I give another example to the House? Let us say that a terminally ill patient dying from cancer has a cardiac arrest and could be resuscitated with cardiac resuscitation. If the doctor decides not to provide that treatment in the best interest of the patient, with the purpose of letting the patient die, is that what the Bill will prevent?

Dr. Brand: I do not know. I am not a lawyer. As I read the Bill, however, it would prevent just such a thing.

An earlier example was the kidney patient on renal dialysis. That patient can refuse further dialysis and therefore choose to die. If that patient cannot make that declaration and goes into a uraemic coma, and if the renal physician had been aware of his feelings but the patient had not been fit enough to refuse dialysis, should he impose dialysis on the patient, or could he allow him to slip away? According to the opening remarks of the hon. Member for Congleton, I imagine that it would be incumbent on the renal physician to dialyse, otherwise he would be committing murder. I find that extreme. There is a real difficulty because the Bill seems bland and innocent, but some of the arguments around it are fairly extreme.

Mrs. Ann Winterton: The Bill describes a purpose against which judgments can quite easily be made. No treatment that is burdensome to a patient needs to be undertaken when that patient is dying. That is established practice now. No tubal feeding need be proceeded with if the doctor's purpose is not to impose treatment that will be burdensome or will not improve the health of the patient. However, the Bill is absolutely clear when the intention behind the withdrawal of food and fluid is for the purpose of ending life. If food and fluid is withdrawn by whatever means, a horrific death occurs. The next step is when relatives are distressed when food and fluid has been withdrawn and say, "Please, doctor, will you give Aunt so-and-so something to put her out of her misery?" If basic hydration and nutrition is withdrawn, the patient is killed. In terms of the Bill, the doctor's purpose is the telling factor.

Dr. Brand: That was a good intervention, but it does not relate to the Bill's contents, which cover "medical treatment", which is a wide term. The Bill does not specify uncomfortable, intrusive or unexceptional treatment.
Another misapprehension relates to the clinician's motivation in making the decision. The people who drafted the Bill believe that doctors are cleverer than they are. I cannot know whether a patient will derive the benefit that I seek from any intervention that I make. I can only know that my action will probably help that patient because it has helped others in similar circumstances. I can say that withdrawing or not prescribing antibiotics for bronchial pneumonia may lead to death. However, I have frequently been proved wrong, and I am pleased that there are higher powers than doctors to deal with those ultimate questions. There is a difference between actively knocking out the bronchial pneumonia sufferer with morphine, thus causing death, and withholding antibiotics.

Mr. Blunt: The hon. Gentleman talks of lack of clarity and confusion. When I asked my hon. Friend the Member for Congleton (Mrs. Winterton) about Lord Browne-Wilkinson's opinion in the Bland case, she agreed with his definition as purpose of treatment to shorten a life. If a doctor withdraws treatment in the knowledge that a likely consequence is shortening a life, that action is defined as purpose, despite the other definitions that my hon. Friend provided. There is a basic confusion about purpose, which makes the Bill as it is currently drafted flawed.

Dr. Brand: The Bill hinges on motivation and purpose. That makes the meaning extraordinarily difficult to tease


out in a court of law. One can always claim, "I knew there was a likelihood of this person dying, but that was not my primary purpose." That takes us back to the secondary purpose argument.

Mr. Steve Webb: I have great respect for my hon. Friend's knowledge, but, to avoid doubt, will he confirm that he speaks from his personal experience, that there is no party line on the issue, and that several of his hon. Friends oppose his views?

Dr. Brand: I intended to mention that as I wound up. I, like other hon. Members, speak as an individual on a private Member's Bill. We are considering an important subject, which is a matter of personal conscience, and we have different views.

Mr. Patrick McLoughlin: The hon. Gentleman's experience leads the House to listen to him with care. However, an important purpose of a private Member's Bill is to get an issue raised. The Bill should be considered in Committee, so that some of the hon. Gentleman's points can be fully discussed. There is not sufficient time to do that today.

Dr. Brand: I would have had some sympathy for that point if the Bill had been drafted in a slightly broader way.

Dr. Julian Lewis: Let it be amended in Committee.

Dr. Brand: The Bill is not amendable because its premise is that acts of omission equal acts of commission. A Bill on euthanasia, which spelt out clearly what could not be done, would have been great. We could then have argued whether omission and commission were the same, and whether basic hydration and food constitute treatment. However, we have missed an opportunity.

Mr. Tony McWalter: Although the hon. Gentleman's primary purpose in the cases that he has cited from his personal experience was not to hasten death, one of his purposes was to do that, and the Bill claims that if hastening death is a purpose of the person responsible for the care of the patient, he is guilty of murder. Does the hon. Gentleman agree with that analysis?

Dr. Brand: The Bill states clearly that action by the person responsible for the care of the patient is unlawful
if his purpose or one of his purposes in doing so is to hasten or otherwise cause the death of the patient.
The hon. Member for Congleton equates that to murder. I am, therefore, a multiple murderer under the terms of the Bill.
When I had been qualified for a couple of years, I worked as a senior house officer in paediatrics for a year. I looked after a very brave two-year-old kid who had leukaemia. The child suffered many recurrences, which involved a lot of unpleasant treatment, including drips and injections. I could not tell—the consultant could not tell, nobody could tell—whether further treatment would have been successful. However, one Tuesday afternoon, during

yet another flare-up, the parents said that neither they nor the child could cope with it any more. They asked for all the tubes to be taken away and to be allowed to sit with him. They did, and he died 48 hours later. That was a profound experience. That was not dual effect, for which the arguments of the hon. Member for Congleton allow, but active withdrawal of treatment for a condition that might have responded to treatment. Clearly, I did not withdraw the treatment with the purpose of killing that child, but to prevent further distress to that child and his family. I allowed a death to occur, and that removed distress. The purpose of my action was, therefore, to promote death or at least to enable death to occur. That is an important point.
The hon. Member for Congleton asks us to second-guess God by claiming that we should continue doing whatever we can to keep people alive if they are not guaranteed terminally ill. I cannot guarantee that someone is terminally ill, or how long a patient will live. However, clinicians—and I include the wider team, because nurses have as much, if not more, input, than doctors—relatives and the patient should be allowed to say, "We do not want any further treatment. We want you to stop treatment, even though it may hasten death." Under the Bill, that would become difficult.
I am also worried that the Bill would prevent doctors from initiating treatment because they could get away with not initiating treatment, but not with the decision to switch off and stop treatment. For example, after a stroke, it is right to provide all the high-tech treatment, set up drips, insert tubes and ascertain how people get on. However, if the patient remains vegetative after a week or more, and further progress will not occur, it is clearly humane to be able to withdraw treatment, even though that withdrawal causes death.

Mrs. Claire Curtis-Thomas: As the daughter of a mother who existed in a clinically defined permanent vegetative state for more than six months, came out of it and went on to live as a quadriplegic with a very good quality of life for five years, I strongly object to the hon. Gentleman's point that it is appropriate for a doctor to withdraw the treatment that sustains life after a week. That is profoundly morally unacceptable to a significant number of people in this country and has led my hon. Friend the Member for Congleton (Mrs. Winterton) to produce the Bill to curtail that limited understanding of what constitutes life and what should be preserved. The Bill does not advocate—

Mr. Deputy Speaker: Order. I must stop the hon. Lady there.

Dr. Brand: That is an extremely valuable intervention and I look forward to it being expanded in a speech. [HON. MEMBERS: "In Committee."] That is up to the House. May I respond to the very valid question that was raised? There is no doubt that there is a need for clearer guidelines, but they must be guidelines and they must be worked through, and not from the particular narrow point of view that all life needs to be sustained, no matter what is done to sustain it. The right to life should not deny a person the right to death and the fact that someone is not dying does


not necessarily mean that he is living. [Interruption.] When I sit in the House I sometimes think that I am not dying, but it is not exactly life as we know it.

Mr. Desmond Swayne: There is a measure of profound agreement with what the hon. Gentleman says among Members on both sides of the argument, certainly with respect to the anecdote he told—I found myself in agreement with him. It is not my perception that the Bill would outlaw what he described; it is a matter of argument. He has referred to the drafting several times and said that the Bill defies amendment. Is that his personal hunch or has he sought advice from the Clerks?

Dr. Brand: I have not sought advice, but I immediately noticed that the Bill's title includes the words "prevention of euthanasia". However, the Bill does not address that; it deals with acts of omission versus acts of commission. It represents a missed opportunity and I am afraid that I shall vote against Second Reading.

Mr. George Galloway (Glasgow, Kelvin): I warmly congratulate the hon. Member for Congleton (Mrs. Winterton) on introducing this important Bill to the House. She stands sentinel on these ethical questions in the House of Commons and Parliament, and the country should be grateful to her for that. I am neither a doctor nor a lawyer, so I shall not detain the House with any technical matters, either legal or medical, but if war is too important to be left to generals, then the mightiest of ethical issues—life and death—is certainly too important to be left to doctors and lawyers.

Mr. Ashton: Or politicians.

Mr. Galloway: My hon. Friend says, "Or politicians," but we are supposed to represent the country—we are elected to do so—and we should echo the points of view of the British people. We do that, by and large, and certainly no one else can do so.
If I had not believed before I came into the Chamber that these issues were too important to be left to doctors and lawyers, I would by now have had the view that it is profoundly confirmed, particularly by the hon. Member for Isle of Wight (Dr. Brand)—the general practitioner on the Liberal Democrat Benches—whose speech I found disturbing, alarming and chilling. I was grateful for the intervention of my hon. Friend the Member for Hull, North (Mr. McNamara) at the point at which I thought the hon. Gentleman was about to incriminate himself. Inspector Knacker of the Yard was about to appear at the Bar of the House, so I was glad that he was diverted from an extraordinary, ill-prepared stream of consciousness. However, it was extremely revealing.
My hon. Friend the Member for Crosby (Mrs. Curtis-Thomas) intervened but has left the Chamber—distressed, I think, by the hon. Gentleman's contribution. Personal experience makes me, like my hon. Friend, particularly angry at the hon. Gentleman's speech. My own father died of a stroke. After exactly a week, his doctor put to me the very point that the hon. Gentleman made: treatment should be discontinued. From that moment, I profoundly distrusted my father's doctors and

harbour a resentment against them still, which is probably unwarranted. He probably would have passed away in any case, but my trust in the doctors was undermined by their suggestion: "Well, it's been a week so perhaps we should stop treating the pneumonia that accompanies the stroke. He is still vegetative"—which I think was a word that the hon. Gentleman used. That profoundly upset me and the rest of my family and led us to distrust each and every thing the doctors said thereafter.
I believe that the Bill is not against the medical profession. A Conservative Member made this point: it has been introduced not because we want to distrust doctors or because we do not respect them, but to buttress and protect their integrity so that no one will be in any doubt as to the motives and purposes from which they speak. It should be supported.

Dr. Julian Lewis: I support what the hon. Gentleman says. I am close friends with a family in the Netherlands, where euthanasia was legalised. The father collapsed from a heart attack and, after a short time, attempts at resuscitation were given up. The family have never been able to trust the doctors again and believe to this day that that decision was made because the general respect for trying hard to save life had been undermined by the introduction of euthanasia. That has had a knock-on effect.

Mr. Galloway: The hon. Gentleman makes a good point. We have to support the Bill precisely because we do not want to go down the road towards euthanasia.

Ms Drown: Will my hon. Friend give way?

Mr. Galloway: May I proceed with this section of my speech?
No one is introducing to the House a Bill to legalise euthanasia. Indeed, almost everyone except cranks says that they are against euthanasia, but it is clear that we have creeping euthanasia in this country—euthanasia by the back door, by court judgments rather than judgments made here in Parliament, and by general practitioners. I am very glad that the hon. Member for Isle of Wight is not my GP. People are making those decisions without any ethical guidelines from the House of Commons and making those judgments without reflection and without taking the temperature of the British public, who should be the ultimate arbiter of such issues.

Ms Drown: rose—

Dr. Tonge: rose—

Mr. Galloway: I give way to my hon. Friend the Member for South Swindon (Ms Drown).

Ms Drown: I thank my hon. Friend for giving way. I understand and am distressed by the story of his experience with his father, but does he agree that it is equally distressing to think of those who are in a persistent vegetative state for many, many years? Surely many people have the inkling or feeling that they would not want to live like that. Has he a solution to the problem? Perhaps we should discuss living wills to enable people


regularly to consider what they would want to happen should such an event occur. I feel that that is the solution that we should be discussing.

Mr. Galloway: I understand my hon. Friend's point of view, but there is a problem. My hon. Friend speaks of a persistent vegetative state lasting for years; but after only a week, the hon. Member for Isle of Wight was ready to omit or commit acts, one of the purposes of which would be deliberately to cause death. My hon. Friend the Member for Crosby told us that her mother had been in a so-called vegetative state for six months, and had gone on to live for five good years, loving and loved by her family.
There are tremendous ethical problems. I take the old-fashioned, perhaps unfashionable, view that only God can decide—only God is fit to decide—who leads this life and who does not.

Mr. Ashton: Professor Bryan Jennett of Glasgow, a specialist in comas, says that no one in a coma has ever lived for longer than a year—although the longest anyone in a coma has been kept alive is 36 years, according to "The Guinness Book of Records", and up to 2,000 people may be in a coma at any one time.

Mr. Galloway: That is preposterous rubbish. Many people have emerged from comas.

Rev. Martin Smyth: I am amazed that any professor gave such a statistic. Any hon. Member who cites it obviously does so with no knowledge. A woman who went into a coma during childbirth emerged from it after 16 years, to the amazement of the person who found her out of bed.

Mr. Galloway: I am astonished that my hon. Friend the Member for Bassetlaw (Mr. Ashton), who takes an interest in these matters, should cite so obviously bogus a statistic.
There is a whole industry out there full of people who note court decisions, look for any sign of weakness and, for some peculiar and bizarre reason, dedicate themselves to advancing the frontiers of euthanasia. Some make a practice of it in the United States and elsewhere. That is why it is so important for us today to send a message stating clearly where Britain stands on the matter.

Dr. Tonge: The hon. Gentleman says that we should not rely on doctors in this context, and I entirely agree.
Is it not up to every individual to make it clear to doctors and relatives how he or she wants to die? The hon. Gentleman is making a very good speech, which is an excellent argument for advance directives and living wills.

Mr. Galloway: I think that that is beyond the scope of the debate. Let me say in passing, however, that people can change their minds. When people are fit and strong, they may have a take on the issue that they will not necessarily have when they are much further down the line. I do not agree with the hon. Lady, because I do not believe that it is for us or for others to make decisions about whether we live or die.

Dr. Tonge: Many people, whom I respect although I do not happen to agree with them, do not believe in God

or in life after death. Why, in their lives and their deaths, should something be imposed on them that they simply do not believe?

Mr. Galloway: I am not asking anyone to accept my own religious convictions. The Church is not the arbiter in this Chamber; but we are, and I think that we must reflect the prevailing ethical and moral issues among the population that we represent. Indeed, I think that we do reflect them and will continue to do so, in regard to this and other issues.
I must proceed with my speech. I fear that I am already detaining the House for longer than I meant to. The loophole that the hon. Member for Congleton wants to plug has allowed creeping euthanasia following court judgments, and I commend her for what she wants to do. No one should assume that we are in any way critical of the families of Tony Bland or Janet Johnstone, the grandmother in the Law hospital case in Scotland; I have no doubt that their intentions were good. The road to hell is paved with good intentions, however, and this loophole could open the way to other cases.

Mr. Lindsay Hoyle: We have been hearing about services being withdrawn after a week. Is it not the case that they are sometimes withdrawn after 24 hours? Pressure is exerted on families when they are weak and vulnerable, and they make decisions that they may regret later.

Mr. Galloway: Yes. That applies particularly to people who have no religious faith. It was impossible for me to accede to the wish of my late father's doctor, for religious reasons, but someone without the bedrock of belief, feeling vulnerable and shocked because a close relative had suddenly been struck down, might well accede to such a request, and spend the rest of his or her life bitterly regretting it and hating the doctor who made the suggestion in the first place.

Mr. Nicholas Winterton: The hon. Gentleman is making an excellent speech based on experience, and I agree with every word that he has uttered. Can he balance what has been said by two medical Members who take a different view by confirming that many eminent clinicians, professors and experts support the Bill?

Mr. Galloway: That was a timely intervention. The Bill was not produced by the minority of active believers in the House; it is a scientific measure, with unimpeachable scientific, ethical and medical support. It is not necessary to agree with me or with the hon. Member for Congleton on religious matters to support it.
Food and fluid were withdrawn from the grandmother Janet Johnstone, and she lingered for several days, dying a death that we would regard as a war crime had she been conscious. Leaving someone sitting there, and refusing them food or fluid, would be not only murder but murder most foul. It would be cruel and unusual punishment. It would be outlawed in any circumstances. If the death penalty were permitted, no one would suggest that it should be implemented by allowing someone to starve to death over several days. This is cruel and unusual, yet it is permitted following the judgment of a Scottish court. The Bland case is very similar, if not identical.
The consequence of our allowing those judgments to go unchallenged—we must set the parameters within which courts make judgments—can only be to accelerate and to give power to the demand for euthanasia. If I am asked, "Should someone be allowed to starve to death over several days, or be injected and killed?" and those are my only two choices, even I will have to opt for the injection and killing because it is less cruel and less wicked than to starve someone wilfully to death. That is why that loophole has to be closed. It will make euthanasia inevitable, when the clear majority of people in the country do not want euthanasia to be introduced. I believe that the clear majority of hon. Members do not want it to be introduced, either.
The hon. Member for Macclesfield, whom I greatly respect, said that he had agreed with every word I had uttered. I fear that he will not agree with my next words. They are directed perhaps mainly at Labour Members. Euthanasia is the ultimate capitalist policy. Members may laugh, but it is the ultimate capitalist policy because it seeks to dispose of those from whom further profit and surplus value will never be able to be wrung.

Mr. Nicholas Winterton: indicated assent.

Mr. Galloway: I am grateful to the hon. Gentleman. I believe that he agrees with me.
The end point of the process, which I am arguing we are already on, is the medical cleansing of geriatric wards, chronically sick wards and of people who will only ever be a financial cost to society, who will never again be a financial benefit and turn in a profit for anyone, and who can look forward only to using up society's resources.
We are being softened up for that argument. All the time, I see disrespect for old people and for disabled people—the deliberate fostering of the idea that they are a burden. How many articles have we read and how many items have we seen about the ever increasing proportion of old people in our society, as if it were some monstrous carbuncle growing on society, instead of just all of us, our mothers, fathers and grandparents growing old? They talk as if it were some problem that people are living to a greater age, instead of something for which we should be thanking God.
How many times have we read and heard arguments asking how we are going to pay for the treatment of the elderly and saying that there are not enough young people? I agree that there are not enough young people. That is one of the reasons why we need to up the birth rate and why we should thank God for my right hon. Friend the Prime Minister showing the way in that respect. That is the way to tackle the problem: increase the birth rate, not the death rate.
The argument that that section of the population is a burden is deliberately fostered in society. If that debate continues unchecked, old people themselves may begin to believe that they are a burden and sign up to be dispatched, so as not to be a burden on relatives.
On the subject of relatives, in parenthesis—although, of course, it does not apply to the Bland or Johnstone families—I may say that I have come across many families who, metaphorically speaking at least, are sitting at the bottom of the elderly relative's bed, waiting for the off and the disbursement of the will, so I do not think that relatives per se are qualified to sign off other people's lives, any more than doctors and lawyers are.
The deliberate fostering of the sense that old people, disabled people and chronically sick people would be better away is a profoundly unethical, unchristian idea. It comes from those who believe that our only real purpose is to work, to earn and to be individuals when we are strong. It is the weak, vulnerable and those not able to speak for themselves whom hon. Members have to speak for and to protect.
I said that I was old fashioned and indeed unfashionable in some of my views. I clearly am in my last one. I saw the British Medical Association's pronouncements on the Bill and was not surprised. If war is too important to be left to generals and the ethical question of euthanasia too important to be left to doctors and lawyers, it is certainly too important to be left to the BMA.
The BMA is on record as wanting to extend the Bland judgment to stroke victims and to new-born babies. It wants to push the frontier, to open new loopholes and to create the demand for enlarging those loopholes. Before we know it, we will have creeping, back-door, but none the less deadly euthanasia.

Dr. Tonge: It is not only the BMA that opposes the Bill. The Alzheimer's Society and Age Concern also oppose it.

Mr. Galloway: I am surprised to hear that point because Alzheimer's will be one of the next ones down the line. After new-born babies, stroke victims and the persistently vegetative who may or may not recover, believe me, that will be a next one. Would we want an old grandmother to go on dribbling in her chair? She cannot even tell us whether she wants to stay alive. That will be the next demand. My hon. Friend the Member for Bassetlaw is on record as supporting the foul industry of assisted suicide and the rest, so I am not overly concerned about his disapproval of what I am saying, but I am absolutely sure that Alzheimer's sufferers will be the next cab off the rank if the process proceeds any further.

Mr. Edward Leigh: It is not just a "maybe": it is actually in a document from the BMA ethics committee on withholding and withdrawing lifelong medical treatment. It says:
Tube feeding should be withdrawn from patients who have suffered a severe serious stroke or have severe dementia.
The kernel of the hon. Gentleman's comments is that we should not leave it to doctors to decide whether a patient's life is worth while.

Mr. Galloway: That is exactly my point. I could not have put it better.

Dr. Brand: Will the hon. Gentleman give way?

Mr. Galloway: It is probably a good time for me to draw my remarks to a close, but, as I have described the hon. Gentleman's deadly bedside manner so graphically, I will give way to him.

Dr. Brand: If God has decided to visit the old grandmother that the hon. Gentleman described, who is obviously in some distress with her Alzheimer's, with an


illness that is potentially fatal, but treatable, are doctors not right to consider with the family whether that treatment should be given?

Mr. Galloway: That matter is beyond the scope of the Bill. I have a clear view on it, which I am happy to debate with the hon. Gentleman any time of his choosing, but the hon. Member for Congleton has specifically not gone down that path. Hon. Members who want to find an excuse for blocking her Bill are seeking to imply that it tackles each and every one of the ethical issues. It does not. She has drawn it very narrowly and made it as brief as it realistically could be precisely to command the broadest consensus, leaving aside some of the other ethical questions.
The Bill is about "the purpose" of the withdrawal of treatment, food or fluid from patients who are not in a position—who are not mentally at that particular time able—to give a statement themselves about what they wish to happen and are, thus, utterly vulnerable, lying there absolutely at the mercy of the doctor and other medical staff who are treating them. The Bill would make such actions an offence.
The hon. Member for Isle of Wight has—bravely, one might say, although I thought chillingly—described circumstances in which, had the Bill's provisions been in force when he was in medical practice, he would be considered to be a mass murderer.

Mr. Ashton: May I put the record straight? The Alzheimer's Society, in a letter that it must have sent to the hon. Gentleman—it sent a copy to all hon. Members—stated:
The Alzheimer's Society is concerned that the Bill will diminish, rather than improve the quality of care provided to people with dementia.
It is signed by Harry Cayton, chief executive.

Mr. Galloway: It is beyond my imagination how anyone could say that the Bill would be against the interests of sufferers of Alzheimer's disease. At the beginning of my speech, I said that, on this and other occasions, the hon. Member for Congleton has stood sentinel on ethical questions, and I believe that she is guarding the interests of Alzheimer's patients and of the elderly. I am astonished to hear that Age Concern and the Alzheimer's Society are opposing the Bill.

Mr. Blunt: Will the hon. Gentleman give way?

Mr. Galloway: No; I really have detained the House too long, and should like to bring my remarks to a close.
The Bill is narrowly drawn and brief, and it should command support—at least sufficient support to get it into Committee, where the doctors and lawyers can have a field day. Nevertheless, the Bill's general principle should be able to command the support of a wide section of the House, because it reflects the views and values of a wide section of British society. I again congratulate the hon. Lady on promoting it.

Mr. Deputy Speaker: Order. Before I call the next hon. Member, I appeal for brief speeches, as many hon. Ladies and Gentlemen have applied to speak.

Sir Nicholas Lyell: The road to hell is paved with good intentions, and the intention of making a brief speech is one that has shown itself elusive in today's debate. I shall do my best.
Like other hon. Members, I start by congratulating my hon. Friend the Member for Congleton (Mrs. Winterton) on introducing this debate on a deeply important subject. Every speech that has been made today has demonstrated how important it is that the Bill should be sent to Committee, so that hon. Members—the elected representatives of the people of the United Kingdom—have an opportunity to focus on an issue that has so far been too much the domain of the medical profession and of my own profession, the legal profession.
I come from a family of doctors, on my wife's side and my children's side, and lawyers, on my father's side, and I have spent hours discussing the vital subject dealt with in the Bill. The Bill provides a real opportunity to try to take a few steps forwards in a sphere in which I fear we shall otherwise move backwards.
I cannot support my hon. Friend the Member for Congleton fully in her Bill as it is currently drafted. I have real worries about the effect of clause 1, and its reference to "purpose" or "one of the purposes", and the Bill's intention as stated in the long title. I believe, for example, that it would, as she rather suggested, negate the Tony Bland case. That case was taken all the way to the House of Lords, where amicus curiae and leading barristers, putting every point of view, produced a sensible result in those very difficult circumstances. Although I do not want that to be undercut, I also sympathise with many of my hon. Friend's fears. I should therefore briefly state where I am coming from.
I have always been passionately opposed to euthanasia in the broad sense. If we allow any notion that the United Kingdom will permit euthanasia, as that word is generally understood, there is a huge danger that we would induce the fear that, should any one of us become a patient, we would not receive devoted treatment in accordance with the Hippocratic oath. If we go down that road, we shall devalue and undermine the respect and affection in which we rightly hold the medical profession. There are very real dangers there.
From a moral standpoint, I believe that it is our moral and our religious duty to see life through to the end. There are some qualifications to that, and the hon. Member for Isle of Wight (Dr. Brand)—who is himself a general practitioner—made some very valuable comments. We look to doctors, in extremis, to help us on our way. When it comes to terminal cancer or some other terminal disease in which we are in great pain, I think that all of us hope that doctors will give us a little bit more morphine, rather than a little bit less, and enable us to slip away quietly and with dignity.
In the Bill's literal wording, however, the doctor's purpose in doing so must be to hasten death, even if by only a few hours, days or weeks. However, that is the stated purpose. In legislation, it is vital that we get the wording right and that we do not undermine those particular aspects.
There is certainly need for guidance on the issue to the United Kingdom medical profession generally, and I congratulate the British Medical Association on seeking to give that guidance. However, just as we lawyers have


produced guidance running to hundreds of pages, but very few helpful principles—as in the Tony Bland case and other cases—the BMA's guidance, as published on its website, which must run to 70 pages of extremely indigestible material, makes life very difficult for doctors.
The guidance genuinely raises the type of fears about which the hon. Member for Glasgow, Kelvin (Mr. Galloway), with his vision of life from the heights of Highgate cemetery and elsewhere, has rightly warned us. There are genuine fears that medical treatment will be withheld when it should not be, and he gave a valuable example.
There has been too much in the press recently—I know that my hon. Friend the Member for Congleton realises this and rightly drew attention to it—about elderly people, either in hospital or in old people's homes, not being provided with basic food and drink in order to hasten death. I do not know whether those stories are true, but there is no smoke without fire. It is very important that valuable guidance be given on the issue.
I am not a doctor, as is perfectly clear, but I think that there is a significant difference between going through all the business of putting tubes down people's throats, gastric operations to get food into their stomachs and, as the hon. Member for Isle of Wight said, flooding—nearly drowning someone with water to try to get water down their throat, in a very undignified manner—and deliberately withholding ordinary food and drink that the patient might be able to take.

Mr. Michael Trend: Does my right hon. and learned Friend accept that some of the cases that have been in the media recently, if they are true, might have been caused, at least in part, by the Bland judgment?

Sir Nicholas Lyell: My hon. Friend may be right to the extent that, across the country, people have different views on the issue. Some people believe—wrongly, in my view—that we should go further down the route towards euthanasia. I think that we have to be very careful about that.

Dr. Brand: Does the right hon. and learned Gentleman agree that care should never be withdrawn? Tony Bland, for example, was cared for in his last days and weeks. We are really talking about quite different matters: one is caring; one is not actively treating.

Sir Nicholas Lyell: I agree with the hon. Gentleman, who made the point very well in his speech. In those circumstances, I would be glad to have him as my general practitioner. I hope that he will follow the logic of his argument and help to ensure that the Bill is considered in Committee. The BMA and the country need the Bill to be considered further so that the matter can be followed through carefully.
At this stage, I cannot promise my hon. Friend the Member for Congleton that I will support the Bill on Third Reading, as I believe that, in its present form, it is too restrictive. None the less, I believe that she has done the House and the country a real service—and a brave one—in tackling one of the most important issues of our day and our generation. I understand that she is taking advice from very able people in the medical and legal professions and in the legal academic world, and I am

grateful for their willingness to consider carefully the points of detail that we wish to discuss in Committee and on Report. On that basis, I urge the House to give the Bill a Second Reading.

Mr. Kevin McNamara: I too congratulate the hon. Member for Congleton (Mrs. Winterton) on introducing the Bill. It is important as it seeks to close the floodgates on what might have been the consequences of the Bland decision—almost indiscriminate euthanasia in certain cases.
I listened carefully to the right hon. and learned Member for North-East Bedfordshire (Sir N. Lyell) and I agree that there may be scope for producing a clearer definition. However, we need to establish purpose. That is a fundamental issue. If the purpose is to hasten someone's death, the Bill says that it is wrong. I agree. It is wrong ethically and morally and it is contrary to the common Christian tradition and that of other religions. It is also a defiance of the European convention on human rights, which we were so proud to put into our legislation 18 months ago. We look forward to its proper incorporation.
I was the rapporteur of the Legal Affairs and Human Rights Committee of the Council of Europe. It considered the report that was published last year on the treatment of the terminally sick and dying. One clear and direct message from the community of nations in Europe was the degree to which they upheld the idea of the sanctity of life and the need for proper care and attention.
The treatment of people who are ill is not an easy issue, but one bubbling with ethical, legal, moral and medical questions. In addition, it cannot be regarded as absolute, as the degree of medical attention and expertise that can be applied depends on society and its expectations. In poor areas where very little can be spent on medical treatment, questions of intravenous feeding and operations putting tubes into people's stomachs never arise. Neither the money nor the expertise is available. In our society, however, with the advantages that we have and the continuous advances in medicine, not only are those procedures commonplace, but the possibility of the extension of life and of cures, using man's God-given ingenuity to extend hope and improve the quality and nature of life, is important.
Although circumstances will differ, the mere fact that we have advanced sufficiently to be able to feed people intravenously and put tubes into their stomachs should not necessarily be regarded as an extraordinary way of keeping them alive. It is part and parcel of the development of the human mind and the human situation.
The issue has arisen of the quality of life of the people who are subject to such treatment. All too frequently, we draw conclusions from our own perspective without considering that of the person involved.
Back in 1966 when we were discussing the Medical Termination of Pregnancy Bill, I remember reading a letter that had been read out in another place by Lord Iddesleigh. It had been printed in The Daily Telegraph,


which is not my normal bedside reading. However, I found it very moving and perhaps we should bear it in mind when we talk about the quality of life:
Sir—We are disabled from causes other than thalidomide, the first of us having two useless arms and hands, the second two useless legs, and the third the use of neither arms nor legs.
We are fortunate only, it may seem, in having been allowed to live, and we want to say with strong conviction how thankful we are that no one took it upon themselves to destroy us as useless cripples. Here in the Thomas Delarue School for Spastics … we have found worthwhile and happy lives and we face our future with confidence. Despite our disabilities, life still has much to offer and we are more than anxious, if only metaphorically, to reach out towards the future."—[Official Report, House of Lords, 30 November 1965; Vol. 270, c. 1175.]
That statement of concern and principle should underlie our attitude towards the Bill; it is profoundly important. That is why we should uphold the basic principle of the Bill.
My next point may not receive universal acceptance in the House. I was one of the few hon. Members who voted against the Second Reading of the Medical Termination of Pregnancy Bill. At the time, we were told by the then proposers of the Bill that it would deal only with the really hard social cases—those in which the mother's life was at risk, or when the circumstances involved such extreme social conditions that a termination was necessary. However, since the passage of that Bill there have been more than 3 million terminations. We were told that there would be only a few—the equivalent of the Bland case.
Hon. Members underestimate the degree to which passing legislation can affect the attitude of society. That legislation changed the nature of regard for the right to life of the unborn child. I put it to the House that if we blithely accept the provisions in the Bland case, we will raise the question of the cripple and, in the terms of the BMA proposal, the new-born child.
I have had some experience of this subject. I had a grandson who was born after six months. I watched with pain and love how doctors at St. George's hospital and the Hedon road maternity hospital in Hull fought to keep that child alive. However, at the end, the nature of the treatment was causing such enormous distress to the child—with no prospect of the lungs developing—that, the decision had to be taken to stop it. Clearly, that was a cruel decision for the parents, and for the doctors. There is no way that I would argue that the purpose of the doctors was to hasten the death of that child. They would be completely clear under the terms of the Bill.
That is why I found it so disturbing, chilling and profoundly cruel to listen to what the hon. Member for Isle of Wight (Dr. Brand) said. I thought that it was eugenics gone wrong. Those were the arguments of the Nazis—that a child or person is not healthy or suitable, and that we should proceed in the way suggested by the hon. Gentleman. I know the hon. Gentleman, and I would be more than willing to share yet another carafe of beaujolais with him. However, I am not certain that I would want him as my doctor.
In terms of definition, I would have thought that most of the cases that the hon. Member for Isle of Wight cited were covered by the Bill. Most of the difficult cases referred to today would be covered by the Bill, which is concerned with the purpose to kill or the purpose to

shorten life. I hope that the hon. Gentleman would not say that it was his purpose to shorten a person's life or to kill that person.

Dr. Brand: I am surprised at the hon. Gentleman's interpretation of what I said. I said that the purpose of the withdrawal of treatment at that time—I was talking about a child, as he spoke about the grandson that he lost—was to allow nature to take its course and for death to occur. There is a vast difference between that and the hon. Gentleman's interpretation. That is the real argument that some hon. Members accept although, clearly, others do not.

Mr. McNamara: The hon. Gentleman said that the treatment of the child was becoming intrusive and that when it was becoming an assault on the child, the parents took the decision. I understand that. However, there is no way—certainly from what he said of the parents—that they said, "This will hasten death, and that is the purpose of what we are doing." From his own description of the case, it was not like that. He said that the treatment was intrusive and an assault on the child, and that there was no certainty of any success. I recommend that the hon. Gentleman read the report on this issue by the Council of Europe's committee—of which, sadly, he is no longer a member. It goes into these questions a great deal.
If we do not put a stop to this behaviour, it will become, like the BMA's guidelines, a slippery slope in terms of who is and who is not valuable in society, who decides, and on what basis and criteria. The only person who is not deciding is the person involved. We can only second-guess, at best, what their opinion might have been, because they would always be entitled to change their minds.
A person has a right to deny treatment, and to say that they do not want such violations done to themselves. A person has the right to want that to stop. However, we do not have the right, and doctors do not have the right, to say that we will take that decision purely and simply to terminate a person's life or hasten their end. We as a society cannot accept that, and that is why we should give a Second Reading to the Bill.

Rev. Martin Smyth: The hon. Member for Hull, North (Mr. McNamara) and I differ on certain issues, but we are at one on this one. The hon. Member for Glasgow, Kelvin (Mr. Galloway) referred to the Christian position, but we are joined on this issue by people of the Muslim faith, the Jewish faith and those who do not profess any faith. This is a deep human issue, with moral implications.
I was fascinated to discover that the hon. Member for Isle of Wight (Dr. Brand) recognised that sins of commission and sins of omission are of equal heinousness in the sight of Almighty God. In other words, he has been well brought up. I would say that one can do wrong by deliberately committing, and one can do wrong by deliberately omitting—sometimes not even by deliberately omitting, but by failing to do what was needed at a particular time.
I join other hon. Members in congratulating the hon. Member for Congleton (Mrs. Winterton) on coming first in the ballot. The right hon. and learned Member for


North-East Bedfordshire (Sir N. Lyell) said that he may not vote for the Bill on Third Reading. He might discover that, as happened earlier this week, many who are not here at Second Reading will vote on Third Reading in favour of the Bill.
We have to face reality, and I try to do so. I have served for 29 years as a pastor, four of which involved a chaplaincy in a hospital with which I have close links. For 18 years, I have been deeply involved as the Ulster Unionist party health spokesman, and I have an awareness of what is happening not only in Northern Ireland, but in the nation as a whole. Internationally, one sees the drift on this issue, which is manifested in the way we treat people who need what the hon. Member for Isle of Wight describes as "care".
Often in hospitals and residential homes, the staff are so hard-pressed that they do not have the time to feed patients properly. That is an indictment of our society. We must recognise that food is treatment. The old adage is "Feed a cold and starve a fever". Anybody who says that that does not make any difference must face reality.
Reference has been made to the type of intervention. My nephew—an orthodontist who is now in Australia—developed a system for helping children with severe cleft palate problems to eat. He went to an orthodontists' conference in Nairobi to speak about it. That system was an intervention to allow a person to feed who would not normally be able to do so. It was a good intervention, but he was humbled out there to discover that the problem was not an intervention to help those children to feed but how to get them food at all.
I use that illustration to show that we are aware of the issues. I recall a young man some three years ago who was in a semi-coma after being brutally beaten by a bunch of so-called loyalist thugs and left for dead. His father sat by his bed, week after week, and he clearly never forgot the old adage that where there is life, there is hope. If we legislators signal to the medical profession—or anyone else—that life can be stopped, we will be failing in our duty.
Earlier, I intervened the hon. Member for Bassetlaw (Mr. Ashton). The harsh reality is that people all over the world have been in comas for years and then recovered. I read about one last year in the Reader's Digest non-fiction series. A woman, although she could not communicate, was able to hear and understand what the doctors and nurses said and did. She went through agony at the way she was treated.

Mr. Ashton: Is the hon. Gentleman aware that many doctors say that absolute dogmas do not work? Each case is different, and only the doctors can decide what is best.

Rev. Martin Smyth: Even doctors now would not accept that only they can decide. This is the age of partnerships—consultants, general practitioners, nurses, physiotherapists, occupational therapists and family members can all contribute to decisions, which go beyond the merely medical. The Bill tries to close a loophole that has developed very rapidly.
Interestingly, the BMA has admitted that a body of law has sprung up based on legal decisions. I am worried that to some extent this country is adopting the American approach, whereby judges decide issues of morality in

society, instead of the elected representatives of that society setting the standards that they believe that society should uphold.
I remind the House that the Bill does not encourage unnecessary interventions. Some hon. Members are worried that a section of the medical profession believes that such interventions are warranted. For example, medical researchers sometimes intervene to prolong life unnecessarily when there is little or no likelihood of improvement. They want to advance their medical knowledge, and I appreciate that that may ultimately benefit many people throughout the world. However, the Bill says nothing about that.

Dr. Brand: I should be grateful if the hon. Gentleman expanded that point. Is he saying that non-intervention not to prolong life is not the same as non-intervention to stop life?

Rev. Smyth: I am saying that the problem is that people are terminating life deliberately. The hon. Gentleman himself said that he did not want to play God, but withdrawing treatment or food is playing God just as much as deciding whether a person will die. I was making the point, bluntly, that people have been used for experiments, and that that did not happen only in the second world war. I do not consider that proper, but my point is that the Bill does not cover it.
The Bill does not require doctors to keep alive people who are dying. I am a long-time supporter of the hospice movement, and I am committed to proper palliative care. I cannot accept the imputation that giving a person a drug that will help him or her to endure pain—thereby prolonging life a little—is moving that person towards termination. The hon. Member for Isle of Wight spoke of a family gathering around a dying person, and I believe that that is the best thing. Sometimes we must help people and it is part of my calling as a pastor to be with people at such times. I do not think there is a proper connection between the concept of withdrawing treatment and palliative care. However, such details can be discussed in Committee.
The BMA has referred to a body of practice that makes euthanasia legal, but it is trying to have it both ways. Sometimes the House makes decisions that not every hon. Member agrees with, and which some will try to amend in due course. Similarly, statements from the BMA or the Royal College of Nursing do not necessarily reflect the sentiments of all their members. I have received letters from nurses, doctors and clinical engineers urging me to support the Bill. I gladly do so.

Mr. Marsha Singh: I begin by congratulating the hon. Member for Congleton (Mrs. Winterton) on winning the ballot and choosing this topic for her Bill, which she introduced with an excellent presentation. I cannot match her clarity, nor the passion with which my hon. Friend the Member for Glasgow, Kelvin (Mr. Galloway) spoke, but I shall try my best.
The hon. Member for Isle of Wight (Dr. Brand) said that he could not second-guess God. However, the issue is not one of second-guessing God, but of whether anyone should play God. That is the fundamental principle.
Many of us disagree with the technicality of blocking private Members' Bills and preventing them from making progress. I ask the hon. Member for Isle of Wight whether he will refrain from using his right as a Member of Parliament to block the Bill so that we can pursue these arguments in Committee.

Dr. Brand: Having listened to the right hon. and learned Member for North-East Bedfordshire (Sir N. Lyell), and various points that have been made, I am persuaded that the Bill needs to go into Committee.

Mr. Singh: I rise to speak primarily because of my beliefs on the subject. However, I also wish to reflect the concerns of my constituents and the Christian, Jewish and Muslim organisations which have made their views known to me. Euthanasia is the intentional killing of a patient by act or by omission as part of their medical treatment when the patient's life is felt to be not worth living. I do not think that anybody should have the right to decide that a patient's life is not worth living.
In this country, thankfully, euthanasia is illegal, and that is the way it should remain, even though, with the Bland judgment, we now have a back-door method of euthanasia by withdrawing food and fluid. The problem in changing a principled stance on euthanasia or the law on euthanasia is that once we draw a new line, it can be redrawn time and time again. It may at first be a case of people in a coma, but it will not finish there. Who will be the next to be added to the list, and the next, and the next? Once we draw a line, it can be redrawn according to the politics and society of the day.

Dr. Tonge: I should like to turn the hon. Gentleman's argument on its head. With the advance of medical science, we can prolong life almost indefinitely, and in the future it will be indefinitely. Does the hon. Gentleman not think that that, too, is interfering with God's will, and that we should consider those issues?

Mr. Singh: I am not talking about God's will. I believe that as human beings, our brain produces the technology to master some of the things that have always happened in nature, and to improve our lives by doing so. Letting nature take its course is a dangerous argument. The Spartans, for example, used to put their babies at the bottom of a mountain and let nature take its course so that the weak were killed and the strong survived.

Dr. Brand: It is clear that hon. Members on both sides of the House go in for hyperbole. We all understand that care should always be there for the individual patient, so I do not think that the Spartan argument quite stands up.

Mr. Singh: The hon. Gentleman is probably right.
Euthanasia is illegal in this country, but let us have a look at a country where euthanasia is permitted—Holland. My description of what is happening there will show the House that there is a slippery slope.

Mr. Blunt: On the definition of terms, euthanasia is not allowed in Holland—voluntary euthanasia is legal in

Holland. There is a fundamental difference between euthanasia—which is murder under any reasonable description—and voluntary euthanasia, which is not.

Mr. Singh: I thank the hon. Gentleman for that clarification, but as I continue, he may hear some facts to make him reconsider whether euthanasia in Holland is voluntary or not.

Mrs. Ann Winterton: I am sure that the hon. Gentleman recalls that in 1990, of the 3,000 cases of euthanasia in Holland, 1,000 involved patients who had not expressed any wish to be killed in that way. There is a slippery slope. It is well documented in Holland, and counters the point of my hon. Friend the Member for Reigate (Mr. Blunt).

Mr. Singh: The hon. Lady anticipates some of the points that I was going to make. My figures show that in Holland in 1990, patients had not given their consent in 1,000 cases of euthanasia. There were 2,700 cases of euthanasia or assisted suicide, and in a further 7,000 cases, there was an act of omission by the doctor with the explicit intention of shortening life. In another 15,800 cases, that was the partial intention. According to the magazine "Faith in the Family", the situation in Holland is out of control. In 1990, 20 per cent. of all deaths were the result of euthanasia, in which the doctor's intention was—at least in part—to shorten life.
I am sure that the House will agree that those figures are horrific. They are eye-opening. We do not need a vision of where we might end up with euthanasia; the practical reality is on the other side of the channel. If we reflect on that, we must decide that Great Britain does not want to go down that road.
As has been explained, the Bill was drawn up as a result of the judgment in the Bland case, in which the House of Lords decided that artificial feeding and hydration could legally be withdrawn and that such withdrawal constituted an omission, not a positive act. I respect the eminent Law Lords, but if one withdraws something from someone, that too is an act. However, I accept that the Bill refers to an omission and that we should use that word.
The BMA guidelines, issued in June last year, were also a factor in the introduction of the Bill. They stated that food and fluids constituted medical treatment.

Dr. Harris: The hon. Gentleman might find that, if he considers those guidelines carefully, they point out that the Law Lords in the Bland case ruled that artificial giving of food and fluids counts as medical treatment, whether it be intravenous or through a gastrostomy tube, surgically placed during an operation under general anaesthetic.

Mr. Singh: I accept that. My point is that, with those guidelines, the BMA is encouraging a wider group of doctors to view food and fluids as medical treatment. That is a dangerous path to take.
The publishing of those guidelines has led many people to fear—whether their fears are real or not—that in this country there is a creeping euthanasia culture. The Bill would put a stop to that. It is both timely and necessary. If euthanasia were introduced as an answer to, difficult and extreme clinical problems, there would be a strong economic temptation to save resources and time by


bringing life to an end sooner rather than later. I am sure that that temptation would arise. If I may revert to new Labour parlance, that would present a huge risk to the many in an attempt to provide an answer for the few.
The Bill will not prevent doctors from ceasing tubal hydration and feeding when its provision has become too burdensome for the patient. However, it will prevent doctors from intentionally bringing about the death of their patients by actions that they take or omit to take. The problem of omission is the loophole that resulted from the Bland judgment; the Bill will close that loophole. The Bill will make it an offence for a doctor to withdraw or withhold from patients treatment or sustenance, if one of his or her purposes is to hasten or cause the death of the patient.
Care for the vulnerable, the elderly and the terminally ill should never be about cost or convenience— it should be about dignity, proper palliative care and better standards of care. We should be very wary of the argument that euthanasia is a compassionate act or a mercy killing.
I received some information today: in cases where hydration has been withdrawn, it takes 16 days for the person to die. Is that compassionate or merciful? I think not. If it is so compassionate and merciful, why is it that in Holland elderly people carry passports for life, to avoid euthanasia if they happen to end up in hospital? That does not sound very compassionate to me.
Mention was made of Happi, a woman in New Mexico. We read about her in the newspapers, under headlines such as "Coma wife wakes after 16 years". She went into a coma after complications in childbirth. She was in a catatonic state, unable to eat, speak or move, and was kept alive on a life support machine. Sixteen years later, she awoke. Very soon after, she was able to swallow food, move a little on her own and talk.
What would have happened to that woman in the United Kingdom? Would she have been denied the right to life when it eventually came? I think that, given the Bland judgment, she would have been executed by the withdrawal of medical treatment or nutrition and hydration.

Dr. Harris: The hon. Gentleman should be careful. I am not aware of the details of that case, but "persistent vegetative state" is tightly defined and it does not involve patients who are mechanically ventilated on a life support machine, as the hon. Gentleman suggested that that person was. It is very dangerous to take an anecdotal case from the world's press and say that that has implications. In contrast, judges in cases such as Bland, where there is no statute law, have made their judgments based on the global evidence and specific definitions.

Mr. Singh: I thank the hon. Gentleman for that intervention. My argument is that doctors do not always get it right; in fact, in very many cases they get it wrong. I do not want them taking decisions about people's lives.

Dr. Tonge: Will the hon. Gentleman give way?

Mr. Singh: I am concluding my speech. I have given way numerous times.
For me, this is a Bill for the Happis of the future. It will reassure many elderly people, and it is a Bill for life. It deserves the support of the House.

Rev. Ian Paisley: Much has been said in the debate, but I shall be the first to congratulate the hon. Member for Congleton (Mrs. Winterton), who brought the Bill before the House. We are again indebted to her for her eagle eye and defence of principles that some of us believe in and really want maintained for the benefit of all people in this country.
I of course approach this subject as a Christian, but I am glad to say that those of other denominations, of no denomination or of other religions are agreed on the matter. It is good that there is wide agreement on it.
I believe that the vulnerable, the elderly and terminally ill require more, not less care; more, not less respect; more, not less support; and that they do not deserve killing. I want to make that very clear today. Killing is not the answer. The answer is more care, more respect and more support.
The hon. Member for Glasgow, Kelvin (Mr. Galloway) mentioned some of the undertones of what is called "mercy killing." As he said, there is pressure to free hospital resources and pressure from the greed of the beneficiaries who want to inherit.
My colleague, the hon. Member for Belfast, South (Rev. Martin Smyth), spoke about his experience as a minister of the gospel. I have been 52 years in the pastorate and I am alarmed at the rush to get elderly people out of hospitals and out of real care. I salute the work of the hospices. Without the hospices, I do not know what many elderly people would do. The hospices believe that we should call for more care, not for less, and they refuse to accept the pressure that is placed on hospitals. They offer the elderly what they richly deserve. Any country can be judged on how it treats its children and its elderly. This country will certainly be judged according to that principle.
I am alarmed at the attitude of the BMA. It has persistently sought to widen the grounds for the withdrawal of treatment. If people have no confidence in their doctors when they are ill or severely ill, a shadow is left over them that they are not able to bear along with the physical trials that they face. The BMA wants to use the pressures as a loophole to widen the opportunity for what it would call "mercy killing".
The Government's response to the "Who Decides" consultation paper was entitled "Making Decisions", and I regret it. The withdrawal of treatment should not be a matter for a court of protection. The fundamental issue is the right to live and no court should be allowed to make the decision for me or anyone else. That is an important principle.
Far be it from me to praise anything from Europe, but the right to life is a principle of the European convention on human rights. There is some advantage to being in Europe and putting one's view at various times and in various places.
I shall be brief, and I am sure that the House will be glad of that. The Bill will prevent doctors from intentionally being able to kill their patients. I was alarmed by some of the things said from the Liberal Democrats' Front Bench by the hon. Member for Isle of Wight (Dr. Brand), and I think that the county would be alarmed, too.
The Bill follows the Bland case in which a patient was permitted to starve to death. That loophole must be plugged. The Bill is about people, not abstractions. Death


is not the answer to medical problems and need. Medicine should be about life, not about affirming the principles of how people can die and die quickly.
The Bill is about the many, not the few. Only a few people are concerned about pushing the case against the Bill. We should seek cures not cuts and, if the Bill receives a fair wind, it will provide a signal to the whole country that a large section of our community is not prepared to sit idly by and allow mercy killing to continue.
I recently read a study on the issue, which said:
More than half of all the patients retained consciousness until shortly before death. Basic interventions to maintain patients' comfort were often not provided: oral hygiene was often poor, thirst remained unquenched and little assistance was given to encourage eating. Contact between nurses and the dying patients was minimal; distancing and isolation of patients by most medical and nursing staff was evident; this isolation increased as death approached.
That is not a good way to have patients die, and it is something that we should all be alarmed about.
If the Government are truly interested in good health care, they should start with compassion for the sick—all the sick, even those who are dying. The argument is about resources, technology and research—it is about cutbacks, in every sense of the word. It is also about how we care for all, not only the dying. The needs of a seriously ill person and a terminally ill person are very similar. Killing cannot ever be a substitute for dying. The whole concept of mercy killing is so open to abuse that it can never be properly policed or legislated for.
Christian values are being assaulted. As a Christian, I trust that those values will be upheld by giving the Bill a good send-off to Committee. I trust that any improvements necessary to establish and defend the right to live will be made there.

Dr. Brian Iddon: I was brought to the debate by the publication of the BMA guidelines in June 1999. In my opinion, doctors should not have the right—at least, not the sole right—to withdraw food and drink from a patient, especially one who is clearly not dying. As other hon. Members have said, food and drink are basic necessities of life. The BMA made an extremely dangerous decision in publishing the guidelines, which are not supported by a considerable number of its members. In that sphere of medical practice, it is not sufficient for the BMA to give doctors "guidance notes" that are likely to be followed to the letter. Instead, it is important to define the position in law—to state, within reasonable limits, what doctors can and cannot do. That is what the Bill is designed to achieve.
I do not want to over-litigate the health sphere, in which clinical evaluation, evidence-based medicine and considered opinion are paramount to provide the optimum care to patients. I pay tribute to all those staff—doctors, nurses and others—who perform the tremendous task of treating and caring for patients throughout the NHS. That should be said in today's debate. I am here to protect the interests of those who have no voice: the elderly, the weak and especially the extremely infirm. In this country, euthanasia, including involuntary euthanasia, is unlawful. The Bill is designed to define the law so that patients and their relatives will have recourse to the courts where that is necessary.
Debate is urgently needed in the light of the trend apparent worldwide in the medical profession, signalled in this country by the publication of the BMA guidelines. Given that there are nearly 115,000 doctors practising in this country, it is regrettable that the consultation exercise that preceded the publication of the guidelines resulted in the receipt by the BMA of only slightly more than 2,000 responses. A considerable number of those came from members of the general public and various organisations. That is a small return, on the basis of which the BMA decided to publish extremely important guidelines, which have prompted today's debate.
Many doctors who are members of the BMA have expressed dissatisfaction with the guidelines. The Medical Alliance Opposing the Guidance on Withholding and Withdrawing Food and Fluids, has been set up; it already numbers among its membership 6,000 doctors—three times the number of respondents to the consultation that led to the publication of the guidelines. GP Anthony Cole, a founder member of the alliance, has criticised the guidelines as being tantamount to the introduction of a death ethic into the doctoring profession in this country.
In 1991, The Lancet reported that voluntary euthanasia by administering legal drugs at the patient's request seems to have been carried out in the United Kingdom in 1.8 per cent. of all deaths. In my opinion, the percentage is much greater than almost 2 per cent.
The authenticity of a patient's request is clearly not easy to validate.

Mr. Blunt: Will the hon. Gentleman give way?

Dr. Iddon: No. I want to make progress because I know that other hon. Members want to speak.
Last year, the medical profession displayed mixed reactions to the case of Dr. David Moor, who was acquitted of the murder of a terminally ill 85-year-old patient by an overdose of morphine. Of greater concern is the case of the now sadly deceased nursing-home patient, Mary Omerod, whose GP, Ken Taylor, withdrew nutritional supplements without discussions with the nursing staff, although the patient's family was consulted. Mary lived from June to August without food and drink. She died extremely emaciated, weighing less than four stones. The GP in question was suspended from practice for six months by the General Medical Council.
Since the debate was announced, we have been inundated by information about such cases from across the country, by letter and by telephone from individuals and organisations who are against euthanasia. I have not been referring to isolated cases.
The media are peppered with reports of poor decisions that have been made by doctors, sadly, to the detriment of their patients. Do we have the compassionate health service that we want for our increasingly ageing population? I think not. My hon. Friend the Member for Bradford, West (Mr. Singh) has already referred to the case of Patricia White Bull in the United States, who has recovered to a degree after 16 years in a coma. The question is—it has already been posed—whether she would have lived 16 years in this country under those conditions.
The demographic picture of Britain is changing. The number of people over 65 years of age is predicted to rise by 10 per cent. in the next 10 years. The greatest increase


in numbers will be those who are over 80. Regrettably, a quarter of those over 85 will develop dementia. We must pre-empt these changes by ensuring that high-quality standards of care are available to these people, and not seize upon involuntary euthanasia as a panacea for the demands of the new century.
It is estimated that about 6,000 deaths per day in the United States are in some way planned or indirectly assisted, probably by the double-effect principle, where strong pain-relieving medications are administered that may simultaneously hasten death.
In a study conducted in New South Wales, it was found that more than a quarter of the doctors who were surveyed said that they had taken steps to hasten the death of their patients. The British people must make up their minds—I hope that we are representing their opinions today—and decide whether they want to proceed along the paths that have been taken by other countries such as Belgium, Holland and Australia.
I have cited cases to demonstrate that the Bill does not anticipate the future. Death hastened by commission or omission is already happening throughout the world. Euthanasia is undoubtedly a sensitive issue. We are discussing not only the lives of people or their deaths, but their values. How much do we value human life? To deny a person the enactment of his values at the precise moment of his death must be one of the most irreconcilable of all wrongs.
In 1998, the BMA initiated a consultation exercise on the issues raised by a number of cases, and most notably by the Bland case. As I have already said, more than 2,000 responses were received as part of the consultation exercise. However, who were the respondents? The BMA has not listed them. I cannot find the names of the organisations or doctors who responded. The views of the 2,000 self-selecting people are not necessarily represented by the BMA, yet its guidelines display a significant move towards involuntary euthanasia by claiming to make distinctions between life-prolonging treatment and basic care. It condones the withdrawal of basic life-stuffs, thus hastening death.
The guidelines that the BMA issued in 1999 reveal that it believes that involuntary euthanasia should be routinely condoned without recourse to the courts. However, in 1998, it stated:
An active intervention by anybody to terminate another person's life should remain illegal. Neither doctors nor any other occupational group should be placed in the category which lessens their responsibility for their actions.
In 1993, it stated:
In the BMA's view, liberalising the law on euthanasia would herald a serious and incalculable change in the ethics of medicine.
What has happened to the BMA? It has executed a complete U-turn. It has been followed by the Royal College of Nursing, which expressed one view two years ago, but an entirely contrary view now.

Dr. Tonge: Will the hon. Gentleman give way?

Dr. Iddon: The hon. Lady has almost made speeches through her interventions, but I will allow her to intervene.

Dr. Tonge: I am grateful to the hon. Gentleman, but does he understand the way in which the BMA works?

He criticises the number of people who responded to questionnaires. I do not wish to apologise for the BMA, but it is a democratic organisation. We send representatives of our branches to the BMA annual council, which approved the guidelines.

Dr. Iddon: I am glad to hear that, but the way in which the BMA has misled hon. Members in the past two days by sending out two letters that contain errors is disturbing.
The legal precedent set in the Bland case determined that the medical profession regarded artificial feeding as a form of medical treatment, not that it should be regarded as such in all cases. We should not fall into the trap, as the BMA apparently has, of extrapolating general principles from a borderline case, such as the Bland case, which was determined in the courts.
One of the most common forms of rebuttal by doctors is stating that patients requested assistance to allow them to die. In one study, 60 per cent. of doctors in this country said that they had been asked by their patients to hasten death. How many doctors complied with that demand? Such a request to hasten death may seem an example of an intensely personal moment for the patient, which is met by a caring and empathic response from the doctor. However, how can the authenticity of the patient's request be measured?
One study showed that mild to moderately depressed patients were more likely to exhibit a decreased desire for life-prolonging therapy than non-depressed patients. It has been observed that patients' wishes are not always consistent over time, and can change as disease advances, sometimes in an unpredictable way. How can we be sure that when a patient says yes today, he means yes?
Before doctors decide to omit or withdraw treatment or food and drink, they should consult not only one other doctor, who should be independent of the medical team on the case, but the nurses in the team and close relatives who are involved with the patient. A case conference is appropriate. Although BMA guidelines propose that procedure, I do not believe that it is carried out in all cases of hastened death. In cases of dispute, there should always be recourse to the courts.
I want to refer to palliative care, which has largely not entered the debate. As my hon. Friend the Member for Bradford, West said, voluntary euthanasia is legal in the Netherlands. There are only 70 palliative care beds in the entire country. Such minimal provision stands amid controversy there, and there are reports that euthanasia law is constantly abused. Euthanasia should not be regarded as an alternative to high-quality palliative care.
Palliative care is not only about the quality of life; it is also about the quality of death. Like others, I pay tribute to the hospice movement, which does a wonderful job, and although some do, I wish that all hospitals provided such high-quality palliative care. Doctors should be given instruction in palliative medicine as part of their core training. As far as I am aware, that is not happening. Such training should definitely include the skill of titrating strong analgesics to the patient's pain and condition. There are many routes by which to administer the wonderful drugs of morphine and diamorphine, but I do not believe that all doctors involved with caring for the terminally ill have the skills to administer those drugs as carefully as many of us think they can. We could have debated how the double-effect principle operates


throughout the national health service. I have only anecdotal evidence for my opinion—that is all it is—that double effect is convenient for some doctors to over-hasten death. It is hard to collect the statistics, but if hon. Members walk round the hospitals and talk to relatives who have recently been involved with death they will hear the stories from them.
I began by telling the House that I am here because I am adamantly against the BMA guidelines. I want to protect the elderly, the weak and the infirm, who have little or no voice. We must make decisions because of changing demography, and the medical profession needs guidance from us. We must lay down the law rather than allow it to use its own guidance, as it appears to wish to do. The Department of Health should put much more effort into promoting palliative care throughout the NHS.

Mr. Michael Trend: It is a great pleasure to follow the hon. Member for Bolton, South-East (Dr. Iddon) and I have much sympathy with most of what he said. I shall come to the Bland judgment, but perhaps the House needs to look at double effect again and debate how it is developing.
I congratulate my hon. Friend the Member for Congleton (Mrs. Winterton) first and foremost on her good fortune in securing victory in the ballot and on her good sense. She is a well-known campaigner on such issues and has introduced a timely Bill on a matter about which the public are becoming increasingly concerned as a result of the Bland judgment and developments since it was made. I admire the sense of proportion in her Bill. We have had a fascinating debate and understand that this issue has been highly complex throughout human history, but since the Bland judgment, and after various advice and guidelines were provided by the British Medical Association, we have all been conscious of being on new ground. We must stop and ask ourselves whether that is where we want to be.
As many hon. Members have pointed out, we have arrived at this situation partly because of the extraordinary advances in medical science over recent years, which are wholly welcome. We must also note that those difficult decisions used to be made mainly at home with a family doctor who knew the people involved intimately. Now they are increasingly made in institutions, and it should be legitimate for those institutions to test what they are allowed to do much more publicly.
In modern society, there is also an increasing tendency to delegate responsibility for difficult ethical decisions to those whom we suppose to be experts, as happens in the case of human fertilisation and embryology. That, however, can be only a temporary solution in the most difficult instances. From time to time, it is essential for ethical issues to be retrieved from the experts and, indeed, the courts, and decided here in Parliament. It is only through the House of Commons that ordinary people have an absolute right to be heard, and, in this instance, the voices of the people are what matters most. That point was made strongly by the hon. Member for Glasgow, Kelvin (Mr. Galloway). Apart from his attack on capitalism, I agreed with every word that he said. I do not think I have ever agreed with any word in any of his other speeches, so I was happy to be on his side on this occasion.
We all accept that science moves forward, and by and large we are grateful for that; but the fact that science moves forward does not necessarily mean that we must develop new public doctrines. We can and, in certain circumstances should, insist that modern developments in medical practice conform to a basic code rooted in popular understanding and support. My hon. Friend the Member for Congleton seeks to stop doctors intentionally bringing about the death of their patients, and I believe that her view has overwhelming public support.
Specifically, my hon. Friend addresses the question of whether those charged with the medical care of patients can withdraw nutrition or hydration if that would cause death. I accept that her Bill does not require doctors to strive officiously to keep alive patients who are dying; I also accept that doctors can cease medical care if it is no longer in the overall interest of a dying patient. I accept the doctrine of double effect, which means that doctors can administer drugs to control pain even at the cost of shortening a life.
As I have said, my hon. Friend has a sense of proportion. What I believe she cannot accept—I cannot accept it either—is the view that food and drink should be regarded as a medical treatment, the omission of which would kill a patient.

Mr. Gordon Marsden: I am sure that other hon. Members have, like me, received letters from hospice doctors. Does the hon. Gentleman agree with Mr. Richard Lamerton, from the Hospice of the Valleys, who says that withdrawing medical treatment in this way
 puts doctors in a new world of value judgments which are very dangerous. Those of my colleagues who are happy to dance across this minefield are the very ones I would be most scared of if I found myself in hospital after a stroke and unable to communicate.

Mr. Trend: There has been a good deal of discussion about that today. The question of which hon. Member present we would like to have as our doctor has arisen frequently.

Dr. Julian Lewis: Three Liberal Democrats who are doctors are present, and they all seem to be against the Bill. I cannot resist asking my hon. Friend whether he thinks that being Liberal Democrats makes them believe in euthanasia, or that believing in euthanasia makes them Liberal Democrats.

Mr. Trend: I think that my hon. Friend is being mischievous, although amusingly so.

Dr. Brand: That was a cheap intervention. I said at the outset that I opposed active euthanasia. Indeed, I voted against a ten-minute Bill on the subject presented by the hon. Member for Bassetlaw (Mr. Ashton).

Mr. Trend: I do not think that my hon. Friend was questioning the hon. Gentleman's medical qualifications; I think that he was questioning his party allegiance, which many people find curious.
I read the Bland judgment with as much care as I could devote to it. It is a terrible case. When one reads about it, one's heart goes out to the family of the young boy, especially his father—and also to the judges, who had to


make a very complicated and difficult decision. In the end, the Law Lords were persuaded, although for different reasons, that the decision was justified within the current legal framework. As one of Law Lords put it: they were
forced to take the law as we find it and try to make it work".
They are fascinating judgments. I have enormous respect for them, but I should like the Bill to be passed, so that the courts find a different law.
Initially, I made an intuitive judgment. When I first read of the Bland decision in the press, I felt a cold shiver of apprehension. Whatever the highly complex arguments, my intuitive feeling was that it would lead us into unwelcome territory.
Like all hon. Members, I am sure, I have received a substantial mailbag from my constituents in the run-up to the Bill. For once, I do not detect signs of organised writing. People have written from their own experience, just as we have heard many anecdotes from the experience of hon. Members. My correspondents have precise views on the Bill. All the letters that I have received share the view that it should make progress.
I shall share with the House some of those sentiments—some of the voices that have reached me from Windsor and the surrounding area. In doing so, I hope to make some general points in support of the Bill.
Many of my correspondents are elderly. As one puts it rather well:
As … a senior citizen I think you will agree that I have a vested interest.
It is the elderly who are most likely to feel fear at the ways things are going. I suppose that it will come to us all in the end.
It is interesting that many people who wrote belonged to the medical profession. The person whom I quoted is a retired nurse. Another nurse writes:
I am a RGN and worked as a Community Nursing Sister for 20 years in full charge of giving nursing care to all in the community. We allowed all people to die with dignity. To die with their boots on so to speak.
I am horrified at what is happening now.
She gives an example of a case where someone died of malnutrition and dehydration. It is a harrowing account whose details I would rather not give to the House. She gives a second example of a young girl dying in a hospice with her father next to her. When he asked why the girl had not been fed, the nurse said:
why bother when she is dying anyway?
That will strike a chord with everyone. The father said:
My daughter is dying of starvation not a brain tumour".
That concern is widespread in the country. It is frequently touched on in the correspondence that we have had. To the majority of people, starvation is simply not an acceptable death.
A retired doctor with 25 years experience as a consultant surgeon and 40 years experience in all in the national health service also refers to the practice of withholding assisted feeding from disabled patients under the pretext that food and fluids are medical treatments. He says:
This practice leads to a miserable death by dehydration and should not be allowed.
Others have a strong ethical view. They think that it is our ethical responsibility to protect patients from being intentionally killed by their doctors, either by actions that

are taken, or by actions that are omitted, showing that people fully understand the complications of the Bill. Others believe that
it is a fundamental human right for any person to have sufficient food and water to sustain life until the point of death.
One of my correspondents writes:
To deny this is a denial of our rights if not an affront to basic human dignity.
You may be interested to know that some of my elderly neighbours have been afraid to go into hospital.
We have heard about the experiences in Holland. People are beginning to experience what those people carrying passports for life in Holland are experiencing.
Another correspondent writes:
There is a tremendous difference between doing all one can to avoid as much pain and suffering at the time of death—and actually killing someone. That decision is not for man to make.
There is a strongly held religious view on the subject, and it is very important that it should be respected.
I believe that, in the variety of examples that I have outlined, my constituents accurately depict the various deeply held feelings on the issue across the United Kingdom. We have heard much in the press about recent tragic cases in which hospitals have seemed to fail their patients in their last moments, and there may well be a growing feeling among doctors and nurses that in letting a patient slip away, perhaps through a lack of nutrition, they are acting out of a form of mercy. However, I do not believe that that is the view of the vast majority of people in the United Kingdom.
If that form of involuntary euthanasia—or "silent euthanasia", as one of my constituents called it—is allowed to continue, there will be a fundamental shift in the relationship between patient and doctor, and there will be a growing lack of confidence and trust, as evidenced in Holland. That consequence, on its own, is not a price worth paying. In all the complex relationships that exist between human beings, that between an individual and his or her doctor is surely one of the most important and valued, and one that we do not want to see diminished in any way.
I suspect that the core reason for the intense feelings that the subject inspires must be found at a deeper level. People fear that, unless we respect other people's rights to life and a dignified death, we should not be surprised if other people do not respect ours. We should do unto others as we would have them do unto us.
There is a widespread fear that once the principle that people can be killed by withholding food and drink becomes firmly established, it will lead on to a slippery slope—a slide, as we have heard often in the debate. I understood the case made earlier by the hon. Member for Glasgow, Kelvin (Mr. Galloway) that, if one were given the choice between allowing a patient to die from starvation or from the administration of a drug, the second would seem the more humane course. That is a very vivid example of how slippery slopes develop.
The Bland judgment and developing medical practice are the immediate reasons why this is a timely Bill. The fear about where the current position might lead is a legitimate concern, and the issue needs to be addressed. We also have to protect the vital doctor-patient relationship. Finally, proper respect needs to be given to


those who view life as a gift and as a mystery. Those are the reasons why I shall give my full support to my hon. Friend and her Bill today.

Mr. Tony McWalter: Many hon. Members have prefaced their speeches by stating their general ethical framework, and I shall do the same. My ethical position on the issue is not overtly a Christian or religious one, but is derived from the ideas of Immanuel Kant. Although that tradition has strong connections to the Christian tradition—what I like to think of as the best elements of the Protestant tradition—and the ideas in the tradition command wide agreement in our society, whether people realise it or not, the tradition does not overtly raise the theological issues that some hon. Members have raised today. The tradition will be germane to some of the conclusions that I draw.
I should like to focus on the Bill's implications for the doctrine of double effect. Before doing so, however, like other hon. Members, I offer a testimonial to the hon. Member for Congleton (Mrs. Winterton): she, like other hon. Members, has raised an issue that has precipitated a very considerable correspondence from my constituents.
Many of my elderly constituents are particularly frightened by a variety of matters. They are certainly frightened that, if the Medical Treatment (Prevention of Euthanasia) Bill were thrown out, euthanasia might not be long in coming. To the extent that there is an issue that needs to be addressed, we as politicians are failing to provide many of our citizens with the type of reassurances that they need about their lives and how they are valued. Equally, the hon. Member for Congleton has identified some aspects of the law that are deeply troubling.
Much of the debate has been around whether people should be denied access to sustenance, and we heard a graphic portrayal of the terrible death that can often ensue. The hon. Lady is right to have raised that issue, so there is some sense in the Bill being considered in Committee. Having said that, however, clause 1—its defining clause—includes the word "or" four times. I am grateful to my hon. Friend the Member for North-East Derbyshire (Mr. Barnes) for pointing out that that means that the Bill contains not one proposition, but 16.
The debate has focused on the withdrawal of sustenance by any person responsible for the care of a patient if his purpose is to hasten the death of the patient. That is one of the 16 propositions in the Bill. What about the other 15? Another proposition in this incredibly complex clause is as follows:
It shall be unlawful … to withhold … medical treatment … if … one of his purposes in doing so is to hasten … the death of the patient.
That is a very different proposal.
My hon. Friend the Member for Hull, North (Mr. McNamara), who is no longer in his place, said that the purpose of medical treatment was to cater for the best interests of the patients. That principle should be etched into medical practice. Other hon. Members have said that the primary purpose of medical treatment is often to alleviate pain. However, if the primary purpose of treatment is to alleviate pain, but in doing so it hastens the death of the patient, it could be demonstrated that one

of its purposes was to hasten the death of the patient. So there are major discrepancies between the intention of the Bill and its wording.
We are all drawing on our own case histories—often on the suffering of our own families. I had an uncle—a philosophical farmer—who influenced me a great deal. He was a gentle, kind man who got cancer of the spine. He was taken to a hospital in Dublin where the doctrine of double effect was not particularly well regarded. In Dublin in the 1960s many people took the view that a person suffering mortal torture would get some time off from purgatory and that the only reason God could let anyone suffer was that it was part of his plan. Their attitude to death has been described several times today: "God will take you when it is your time, although he offers human beings the opportunity to alleviate pain." In my uncle's case, the hospital did not countenance any dose of morphine that might shorten his life, even by the smallest amount.
I heard the terrible description of what it is like to die of hunger and thirst. The hon. Member for Congleton rightly addressed that issue, and I have paid tribute to her. However, my uncle weighed under four stone when that medical neglect finally reached its tortured and terrible conclusion.
The doctrine of double effect, which my hon. Friend the Member for Bolton, South-East (Dr. Iddon) was drawing into question, is in part a doctrine which embodies compassion and respect—a key theme in the Kantian ethic—and enjoins each and every one of us to show not merely respect for one another, but reverence. To treat somebody as if they must be denied, on some technical grounds, the kind of care and support that we all owe one another and which we owe our elderly constituents is wrong; it is morally wrong.
Among other aspects of the debate, we have heard from the hon. Member for Congleton that it is up to patients to decline treatment. I can say that I do not want that striving "officiously to keep alive"—I can say no. We have heard cases of someone having cancer and needing kidney dialysis. I can say no to the dialysis until I am unconscious. However, the doctor then has a slight problem. He is not allowed to withhold medical treatment from me if that would hasten or cause my death. If he decides that withholding dialysis would hasten or cause my death, he is guilty, under the Bill, of murder. As a result, having finally got to the stage where I am no longer able to decline treatment, the Bill now enjoins the doctor to take over. It obliges him legally to do so.

Mrs. Ann Winterton: No.

Mr. McWalter: The hon. Lady says no, but much of the debate is about whether people's views should be treated with respect or not. I completely agree with my hon. Friend the Member for Bradford, West (Mr. Singh) about the absolute necessity of avoiding involuntary or non-voluntary euthanasia. However, if my view about my life is that I do not want to be on a life-support machine for 16 years even if a miracle is going to happen—no thank you, I do not want to do that to my family and those I love—others may have a right to say that also.
We have all seen the horror films in which people are conscious and their eyes are open, but people think that they are dead. We have all lived in that horror film and,


from my correspondence, I can see that some of my elderly constituents are living in it. Those late-night films reach their summit when the coffin is opened and the person has been scratching at the lid because they were alive when buried.
We have to make judgments about probabilities. In practice, if I am asked to weigh up the probability of wanting to avoid being a tremendous encumbrance on those I love for many years, or escaping from the coma after 15 years, it is up to me to take the former option. In practice, if people decline treatment, very often that is overridden because of Bills such as this.
My card from the Voluntary Euthanasia Society declines treatment. Now I do not want to die, and I certainly do not want to be put down if I have good prospects, but I want people to accept that the enormous medical effort involved in treating brain-dead people would be inappropriate for me. That does not mean that it would be inappropriate for anyone else: other people can do what they like, but I believe that I have freedom of choice in the matter, and I want other people to respect what I consider to be best when it comes to my life.
However, if my elderly constituents feel uneasy at that, we must acknowledge that unease. We cannot allow people to believe that what I want today will be forced on them tomorrow. That would be the creeping euthanasia that was mentioned earlier. If people are worried about that, we must change the legal framework. People must not be left utterly disconcerted by a patchwork of case law that does not embody clear ethical principles or respect for people's views.
Equally, I do not want doctors, such as those who were too frightened to treat my uncle properly, to risk being arraigned for murder. It is reasonable for the BMA to be worried about the sloppy, 16-fold complexity that is clause 1.
In the end, the debate comes down to the most sombre subject of all—death. We all face our own personal death, and we are discussing the conditions in which other people will decide—or not—that we are near our time, at our time or, possibly, beyond our time. We must address the problem from the perspective that death is part of life, that there is such a thing as a good death, and that one can die loved, cherished, respected and revered. Everyone has a right to such a death, and no one has a right to countermand anyone else's view on a matter that is so near to us all, and so delicate.
In Committee, we must try and ensure that the genuine compassion evident in the Bill is gilded with sufficient logic that the law that eventuates from the process retains a reverence for people, and expresses that reverence more clearly than hitherto.

Mr. Ashton: On a point of order, Mr. Deputy Speaker. I seek your advice about the composition of the Standing Committee. So far, some nine hon. Members have spoken in favour of the Bill, and two have spoken against it. However, I think that at least four or five other hon. Members want to speak against the Bill.
Will the Standing Committee scrutinising the Bill reflect the total number of speakers today, or will it take into account those hon. Members who oppose the Bill but who did not get the opportunity to speak?

Mr. Deputy Speaker (Mr. Michael Lord): That is entirely a matter for the Committee of Selection, not for the Chair.

Dr. Evan Harris: I hope that my speech will redress the balance a little, but first I want to compliment the hon. Member for Congleton (Mrs. Winterton). She not only won the ballot, making all of us jealous, but she put her case very clearly and patiently this morning, and has been very willing to consult people about the way in which the Bill is formulated. Even those of us who do not support everything that the Bill proposes recognise the open approach that she adopted, and are grateful for it. I also compliment the hon. Lady on the stamina that she has shown in sitting through the entire debate and listening carefully and attentively to all the contributions.
As it happens, I am a member of the BMA medical ethics committee. I have had a long-standing interest in matters such as these, but I can tell the hon. Member for Bolton, South-East (Dr. Iddon) that I was elected by the profession to that committee, which contains a wide range of people. However, I would like to make it clear that I do not speak for the BMA medical ethics committee. The views that I express are mine, not those of the committee or, indeed, the Liberal Democrat party, as I think that the hon. Member for New Forest, East (Dr. Lewis) tried to impugn in an earlier intervention.
I believe that the Bill is flawed, and that what it sets out to do is wrong. I do not agree with the end that it seeks to achieve. However, in contrast to my hon. Friend the Member for Isle of Wight (Dr. Brand), I think that it may be—just about—amendable in Committee. It is certainly debatable, and it is appropriate that we should look forward to a Committee stage where, in a spirit of constructive debate, we can discuss the issues and see whether the result that the hon. Lady wants can be achieved in a way that does not invite opposition from so many people.
The BMA guidelines are valuable, and a useful addition to the debate. The Under-Secretary of State for Health in the other place said in response to a question by the Baroness Seccombe that they were a welcome addition. The hon. Member for Bolton, South-East made a powerful speech, but it was regrettably hostile to the BMA and the work of its ethics committee. Those guidelines are based on case law. The hon. Gentleman may disagree with the judgments that have formed our case law, but it is right that decisions about end-of-life issues and how doctors behave are there for people to see. In that way, people such as the hon. Gentleman and the hon. Lady can take issue with them. It is better than having everything done in secret on a "doctor knows best" basis. The fact that there are detailed guidelines that have been subject to consultation, that have gone through the BMA's democratic process, and are published on a website should be welcomed.

Dr. Iddon: Does the hon. Gentleman believe that something as important as that should be based on only 2,000 responses—

Mr. Deputy Speaker: Order. This is the second time that this has happened in just a few moments. Members have referred to "this" or "that" without saying what they mean. Visual aids are not encouraged in the Chamber, and for the sake of the Official Report, it would be helpful if the hon. Gentleman says what he is talking about.

Dr. Iddon: My apologies, Mr. Deputy Speaker. Does the hon. Gentleman believe that such an important


document as the BMA guidelines should have been published on such an important topic, considering that it was based on only 2,000 responses out of 115,000 possible responses and that some of those 2,000 were not members of the British Medical Association?

Dr. Harris: With respect, I do not believe that that is the point. I know that much consulting is done through local medical committees and BMA divisions, which then put a view. There was a very wide debate in the professional medical press about the guidelines, and there continues to be a debate about them at the council of the BMA and its annual representative meeting. They will continue to be debated. I think that any Government would worry if a threshold number of responses to consultations had to be reached before legislation resulting from a White Paper or Green Paper was promulgated.

Mr. Blunt: Does the hon. Gentleman agree that this subject is agonisingly difficult and presents the medical profession, which is at the front line, with hideous decisions to make? Does he also agree that it is rather odd that the hon. Member for Bolton, South-East (Dr. Iddon) should suggest that a three-clause Bill could replace 70 pages of medical guidelines, together with the case law that stands behind it?

Dr. Harris: I agree with the hon. Gentleman. The problem for doctors considering this difficult issue is that there is no statute law, there is only case law. Doctors cannot be expected, I believe, to read the law reports. They should be given a digestible form of advice so that old habits which may be wrong—and, in certain cases, have been wrong—are not simply continued without the due process of audit and check. The Government's quality agenda in the health services, which is backed on the Liberal Democrat Benches and, I believe, throughout the House, seeks to do that. There should be a framework which professionals, not just doctors—and, indeed, not just in the health service—can use to check their actions.

Dr. Julian Lewis: I thank the hon. Gentleman for his courtesy in giving way, but I am not satisfied that he has dealt with the strong points made by the hon. Member for Bolton, South-East (Dr. Iddon). The hon. Gentleman pointed out that the survey was not representative of BMA membership and that, a few years ago, the BMA was making the opposite argument. Why has there been a U-turn?

Dr. Harris: First, there is no U-turn. Secondly, the hon. Gentleman will never be satisfied on some of his points. There was no survey; the guidelines were sent to a large number of members—perhaps all of them—and those who wanted to do so made a response. There is no doubt that the guidelines represent the settled view of the BMA. In any organisation, there will always be a minority who question the general view.
The medical profession is not unanimous in its view on the Bland judgment. It would be astonishing if it were. However, as case law evolves, it is right that the profession should issue its own guidance so that doctors can ensure not only that their actions comply with best practice but—given that the actions of health

professionals are subject to the law and, indeed, the criminal law—that they do not end up being held to account for their actions in court.
The more that I read the guidelines, the more I support them. They are extremely clear. They do not contain the terrible ideas that have been described. Obviously, we should read the full text, but the guidelines include the following headline points:

"1. The primary goal of medical treatment is to benefit the patient by restoring or maintaining the patient's health as far as possible, maximising benefit and minimising harm.
2. If treatment fails, or ceases, to give a net benefit to the patient (or if the patient has competently refused the treatment), the primary goal of medical treatment cannot be realised and the justification for providing the treatment is removed. Unless some other justification can be demonstrated, treatment that does not provide net benefit to the patient may, ethically and legally, be withheld or withdrawn and the goal of medicine should shift to the palliation of symptoms."

Such decisions are taken every day, on every ward, in every hospital. They are set out clearly in the guidelines in the best possible way.
The guidelines continue:
3. Prolonging a patient's life usually, but not always, provides a health benefit to that patient. It is not an appropriate goal of medicine to prolong life at all costs, with no regard to its quality or the burdens of treatment.
We are debating that issue of quality—especially in relation to the Bland judgment—and whether life should be prolonged at all costs because there is some sanctity attached to it that overrules everything else.

Mr. Andy King: I am grateful to the hon. Gentleman for allowing me to intervene. It is good that a member of the BMA ethics committee is in the Chamber. Will he explain why the committee should adopt shoddy guidance, which does not enhance good practice, but reduces it and does harm to the medical profession? I quote from a letter written by Cardinal Winning. He wrote:
The new guidelines are both sinister and worrying. They will cause very sincere anxiety to thousands of patients and their families who will now find themselves in a state of fear and alarm when they have to enter hospital.
He continued:
That this should happen in NHS hospitals"—

Mr. Deputy Speaker: Order. The hon. Gentleman's intervention is long enough. He has made his point.

Mr. Swayne: The cardinal was right about section 28.

Dr. Harris: The cardinal's views on other matters did not cover him in glory. The House should feel strongly about that. [Interruption.] I feel strongly about the matter—as do some Conservative Members in the opposite direction.
There will be subjective views on the guidance. The hon. Member for Rugby and Kenilworth (Mr. King) is within his rights to say that it is shoddy. However, I do not believe that to be true. It would be more helpful to the debate if hon. Members noted—as some have done—that they think that the case law is wrong and that they wanted to overturn that law. I support the case law, but the argument should be about that law, not about guidelines designed to clarify it for professionals working in the


field. To scapegoat the BMA when one disagrees with case law in Bland and subsequent cases is to choose the wrong target.
I shall now discuss a key point: the issue of artificial nutrition and fluids, which the hon. Member for Hemel Hempstead (Mr. McWalter) discussed cogently. The question whether artificial nutrition and hydration should be considered a medical treatment is not dealt with in the Bill. I believe that the hon. Member for Congleton recognises that whether or not it is within the terms of the Bill, if one of the purposes or the purpose of the doctor in withdrawing artificial food and fluids is to hasten death, such withdrawal should not be permitted by statute law. I repeat that the question whether artificial feeding should be classified as treatment or basic care does not impact on the effect of the Bill. I believe that such feeding is treatment, for reasons that I can give.

Mrs. Ann Winterton: The argument about whether food and fluids are medical treatment goes to the heart of the Bill and of today's debate. In 1991, the BMA—the doctors' trade union, which does not speak for all doctors, as not all doctors are members—defined food and fluids as treatment. That was picked up in the Bland case. Many colleagues, and myself, do not concur with the BMA's definition. We believe that food and fluids are not artificial. They may be given by tube or in another way, but food and fluids are not artificial in themselves; they are basic requirements of life, and should be considered as part of basic nursing care.

Dr. Harris: Clarification is helpful. To my knowledge, no one is arguing that orally given food and fluids are not part of basic care. I have been speaking about artificially given assisted feeding, whether it be tube feeding into the stomach; or a tube, such as a gastrostomy, which comes from the outside into the stomach through the abdominal wall, given through an operation under general anaesthetic; or intravenous feeding, which is covered by antibiotics, has a range of important hygienic and aseptic techniques and must be given by trained medical staff.
The BMA, supported by the judges in the Bland case, recognised that such feeding was treatment, but that is academic when we consider the Bill, because regardless of whether it is treatment or is just considered to be food and fluid, the withdrawal of such feeding would be caught under clause 1. As the hon. Member for Hemel Hempstead said, this is not a narrowly drawn Bill in that sense.
I do not consider that the issues raised in the Bill have anything to do with poor care delivered to elderly patients in geriatric wards in the national health service. The stories that we have read recently are of great concern to everyone. I do not believe that such instances are new, and I know that the Government are anxious to prevent such instances happening. Some of the stories that have been told about ill or dying patients having food and drink removed, or not being offered food and drink, are evidence of inadequate basic care, nursing care and medical attention to those patients; they have nothing to do with the Bland judgment or with the things that the hon. Member for Congleton would probably wish to be outlawed if her Bill became law.

Dr. Tonge: Does my hon. Friend agree that many of the instances that we are all hearing about in our mailbags—complaints against people in the national

health service for not feeding people who cannot feed themselves—are a consequence of the shortage of medical, nursing and auxiliary staff in the NHS? That is not just due to underfunding of the national health service by successive Governments. Does my hon. Friend agree that it is the responsibility of the British people to call for higher taxes, not tax cuts, in order to get more staff into the NHS?

Dr. Harris: I think that that point is well made. In fairness to the BMA, it has long called—and certainly since I have been a member—for older people to enjoy standards of treatment and care on an equal basis with other adults.
Elderly patients and their relatives have two fears about NHS treatment. The first is that they will not get the treatments and the care that they need because of rationing or discrimination. The other is that treatments that are not effective will be continued beyond the point that is reasonable or compassionate. I have received a number of letters from elderly constituents who are fearful about the Bill being passed in that it might deter doctors and others who care for patients from acting in a compassionate way because they will seek to prolong life at all costs. I understand that that is not the intention of the hon. Member for Congleton and I have attempted to reassure my constituents that even this Bill, with which I disagree, does not seek to do that. However, the hon. Lady must recognise that that fear stalks the land.
When the quality provisions of the Health Act 1999 were considered, an amendment was tabled in Committee and on Report to put a duty on the NHS not to discriminate on the basis of age unless clinically justified. I am sad to say that that amendment, which was tabled by the Liberal Democrats, was not supported by other parties. I urged the Government to recognise that they should at least live up to the commitment that they had made before the last election to conduct an audit to see whether such practices took place. They gave the commitment to Age Concern and other charities that age discrimination would be tackled. It is a pity that a legislative opportunity was lost by the Government and by the Conservative Opposition because they did not support the amendment.
I turn to the Bland case. Hon. Members have described it as a loophole that the BMA and others may seek to expand. That is a subjective view: one man's loophole is another man's safeguard. Those of us who support the ruling in the Bland case recognise that there must be a safeguard for doctors seeking to withdraw treatment—be that life-support treatment or the artificial giving of food and fluids—from patients in such circumstances. Patients must be safeguarded from the prolongation of life when that is no longer in their interest.
The Bill is designed to drive a coach and horses through Bland. It is not helpful for people to misunderstand what that was about.

Dr. Iddon: Does the hon. Gentleman accept that the Bland decision was a judgment and that the Government have said that they do not want that judgment to be enshrined in statutory law? It seems that the BMA almost envisaged the judgment being enshrined in statutory law.

Dr. Harris: That is a matter for the Government. The fact that the Government do not want statutory law to


apply to such issues is a matter that may concern the promoter of the Bill because of its effect on the likelihood of her ever getting it on to the statute book.
The key point is that, when Tony Bland was 18, he was starved of oxygen after being crushed against the barriers at Hillsborough along with a close school friend of mine, Andrew Devine. I followed the case all the way through when I was at medical school. Tony Bland's family and the local Member of Parliament at the time, who was not a supporter of moves toward euthanasia, made a plea for Tony Bland to be allowed to die peacefully. The court granted doctors the permission to help that to happen. As far as we know, he died peacefully after artificial food and fluids were removed.
We have heard a lot of heightened language about the expression "starving to death". That has been a little glib, even though I understand the intentions behind it. People may die of asphyxia when their brain is starved of oxygen because their heart has stopped; they may die of suffocation when they have respiratory disease—that might not be considered to be pleasant they may bleed to death or, if they have liver failure, they may clot to death. The key question is whether death can be made peaceful, with the patient not in pain. It has to be made clear that, in the event of treatment or artificially given food and fluids being withdrawn, the basic duty remains to ensure that the patient is not distressed or in pain and that symptoms are palliated, so that the patient can die a peaceful death. Talk of the withdrawal of food and fluids inevitably causing distressful deaths is wrong. That is not the aim.
The BMA raised with the hon. Member for Congleton the question whether the Bill would prevent doctors from stopping administering dialysis to a patient who had terminal cancer who did not want further dialysis, but that issue has been dodged by the Bill's supporters. In answer to that case, the hon. Lady said that the purpose in withdrawing dialysis from such a kidney patient who had terminal cancer would not be to hasten death, even though it would hasten death, but would be to carry out the views of the person concerned, expressed when that person was competent. I would question whether that can ever be the purpose in giving medical treatment. Obviously, when giving treatment, one is generally seeking to go along with the patient's views, but it is sophistry to answer that case by saying that withdrawing dialysis, which would hasten death, is not the purpose because the sole purpose is to follow the views of a competent patient.

Mrs. Ann Winterton: The hon. Gentleman has misunderstood my earlier remarks. What he describes is not relevant to the Bill. The Bill does not change either law or practice; all it does is forbid doctors to pursue a purpose of killing a patient by omission. The case he cites is a spurious one that is not relevant to the Bill. The practice if the Bill were passed would be exactly the same as it is now.

Dr. Harris: I accept that the hon. Lady genuinely believes that, but the Bill contains no mention of a competent patient asking for treatment to be withdrawn. She says that no such reference is needed, but if it is not needed, how does she draw a distinction between a competent patient making a decision to have dialysis

withdrawn and a patient who is no longer competent having said in advance that, if he or she becomes terminally ill, no aggressive treatment such as dialysis or life support should be administered?
The hon. Lady says that there is a difference, as do the supporters of her case. But we are in no doubt as to their views on advance directives. A helpful briefing from Right to Life states:
There is currently much debate about whether Advance Directives (living wills) are, or should be, legally binding upon doctors. The Bill will not change the status of such Advance Directives but will make it clear to Government and the Courts that it is not the will of the House that such directives should be given any greater legal force than they already have. It will strengthen the hand of those doctors who are faced with Advance Directives the status and applicability of which may be in doubt by making it clear that the doctor cannot act with the purpose of deliberately ending a patient's life.
In her December press statement, the hon. Lady said:
The Bill … will prevent the development of legally binding advance directives which compel doctors to take action making them complicit in the assisted suicide of mentally incapable patients.
The aim of the Bill's supporters is to detract from the legal status given to advance directives.
What would the hon. Lady do about a patient with a long-standing but progressive cancer of the breast, who may wish to indicate in advance what treatment should be given, withheld or withdrawn should the cancer spread to other organs and the patient become unable to express a view? Would following the patient's informed advance expressed view be open to interpretation as having the purpose of bringing about the patient's death?

Mrs. Winterton: The hon. Gentleman raises an interesting point. If a woman with advanced breast cancer who is mentally competent says to her doctor at the time that she does not wish to have any more treatment, she is perfectly within her rights so to do. The question of living wills is a red herring: they are not currently legally binding and the Government have stated that they do not wish to make them legally binding in statute. Therefore, the case the hon. Gentleman describes would not be affected. I have given him a straight answer: if my Bill were passed, the case would be exactly the same as it is now.

Dr. Harris: These are matters that will have to be discussed in more detail in Committee. If the Bill becomes statute law, with the Act stating that doctors may not withdraw treatment from patients, and there is an advance directive that has backing in case law that it is a valid indication of the patient's wish if there is no reason to think that the patient was not competent at the time or has changed his mind, then there is a balance of case law against the statute. That is why at the very best the Bill will need considerable amendment to make the hon. Lady's point clear. My view, and that of many people to whom I have spoken, including legal experts, is that it is not clear.

Ms Drown: Is there not something peculiar in the intention that lies behind the Bill, which is that it would be all right for someone there and then to say, "I want to refuse this treatment", when we have heard from other hon. Members that they are worried that on one day someone could refuse treatment and on another day wish not to refuse treatment? Yet the proponents of the Bill do


not want to pursue living wills in which people can state consistently over long periods what they would like in certain circumstances. Is it the hon. Gentleman's view that it would be better that people said consistently over a period what they wanted, rather than leaving it to an instant decision?

Dr. Harris: I agree entirely. The question of autonomy for patients is critical. A debate took place in the House of Lords a few days ago which had been promulgated by Baroness Seccombe. During the debate, Baroness Miller said that she was shocked to hear that her mother had been asked on admission to hospital whether in the event of a cardiac arrest she would want to be resuscitated. She took the view that it was outrageous that a patient should be asked for his or her view on that matter and it was outrageous also that she had not been asked for her views instead of the patient.
The House and the public cannot have it both ways. We cannot tolerate any longer a culture where "doctor knows best" and that decisions will be made by doctors about whether to take active resuscitation measures or not without consulting patients. It is unfair to criticise doctors for consulting competent patients about their wishes for intervention while also complaining that doctors are acting as if they know best.

Mr. McWalter: Will the hon. Gentleman give way?

Dr. Harris: I am conscious of the need to conclude my remarks so as to give sufficient time to those on the Front Benches. However, I shall allow the hon. Gentleman to intervene.

Mr. McWalter: The hon. Gentleman has concentrated on the withdrawal of medical treatment. However, the withholding of medical treatment is a much larger category. It is that which will make doctors especially liable to prosecution under the Bill.

Dr. Harris: Absolutely. The issue of do-not-resuscitate orders is important. When people die in hospital, and many do, they run the risk of a bunch of white-coated doctors running along the ward with a trolley and administering electric shocks, and even opening the chest, as in the drama series "ER", to prevent death from cardiac arrest taking place. That can be inappropriate in many cases, but patients need to be asked for their views in a sensitive way. Guidance has come from the chief medical officer that it is not for doctors, and certainly not for junior doctors, to scribble on notes "Do not resuscitate" without consulting the patient, if that patient is competent.
I know that the situation has come as a shock to Members of the House of Lords, and perhaps to Members in this place. That is why we need to debate these issues. The public, with their British reserve, must be dragged away from their view that it is not appropriate to talk about death. In fact, it is extremely important to do so if we want our autonomy to be respected. That was put cogently by the hon. Member for Hemel Hempstead.

Mr. James Gray: Does the hon. Gentleman agree with me that the argument that he is advancing could equally well be advanced in support of euthanasia?

Dr. Harris: Yes, I am aware of that. In my opinion, current practice is not euthanasia, but it is that which the

hon. Member for Congleton wants to stamp out by means of the Bill. Nevertheless, I am on record as saying—my views were known by the electorate before I stood as a candidate—that I want to see liberalisation of the law on voluntary euthanasia, with adequate safeguards. People who oppose the Bill have different views on that. For example, as my hon. Friend the Member for Isle of Wight made clear, the BMA remains fundamentally opposed to voluntary euthanasia. However, there is a utilitarian argument, which claims that, ethically, an act of omission is the same as an act of commission, and that only the end result matters. I believe that if a patient wants the suffering to be ended, doctors should be allowed to do that, with appropriate safeguards, by an act of commission as well as an act of omission. Although that is a separate argument, I have never been shy of expressing my view on the matter.
I want to refer to some of the religious opinions that have been expressed. I bite my tongue when I hear some religions' views, which I find fundamentally illiberal. However, as the Chief Rabbi is the head of the religion into which I was born, it is reasonable for me to comment on his view. On death with dignity, he is quoted in the House of Commons Library briefing as saying:
Ultimately, the test of our humanity is our ability to face our fate and that of those close to us with courage, humility and dedication; not to hasten death because dying has become burdensome.
I disagree. If dying is burdensome, doctors should not be forced to make that death drawn out. I understand the view of the Chief Rabbi, but I do not believe that it is the general view of Jewish people that we should all cope with death, however burdensome, and that there should be no defence against it being prolonged unnecessarily. Heads of religions do not necessarily speak for all the people who subscribe to their religions; the BMA can claim to speak only for its members, not for all doctors.

Mr. Andy King: I wish that the hon. Gentleman had finished the quotation, because it continues:
It is the duty of religious leaders and physicians to preserve this conviction in the conscience of humanity.
Surely it is also our duty to reflect the conscience of our society.

Dr. Harris: That is a subjective view.
The Minister, who has sat patiently throughout the debate, is young. Part of the problem in this country is that young people—and even middle-aged people—see themselves as immortal and will not discuss, think about or plan for their death. Death is inevitable, and ought to be discussed. It is sometimes upsetting to do that, and I respect those whose family experiences have been distressing. However, we must set an example. I hope that we will be able to do that in Committee and on Report and thus consider critical issues fully.

The Parliamentary Under-Secretary of State for Health (Yvette Cooper): This has been an extremely interesting debate. I congratulate the hon. Member for Congleton (Mrs. Winterton) on winning the ballot and on choosing such a serious and weighty subject for her Bill. I also congratulate the hon. Lady on her arguments, which were clear and measured, on an emotive subject.
The Bill covers difficult, sensitive and controversial issues of medical practice. As we heard in the debate, many hon. Members support the Bill because they want to stop what they perceive to be a move towards the acceptance of euthanasia. At the outset, I emphasise that the Government remain completely opposed to euthanasia, by which we mean the intentional taking of life, albeit at the patient's request or for a merciful motive.
The hon. Member for Congleton said that the aim of her Bill is to restore the integrity of the law on murder and to ensure identical treatment for acts and omissions in medical treatment and artificial nutrition and hydration. She also said that she does not want the Bill to make doctors strive officiously to extend life, or to stop doctors respecting patients' rights to refuse treatment or to prevent them from providing appropriate palliative care or withdrawing treatment or artificial nutrition and hydration that is burdensome or no longer of benefit to the patient. I hope that I have understood her correctly, and I appreciate her anxiety to make clear in her speech exactly what she wants the Bill to achieve. However, I do not believe that it would do what she intends—or what she outlined in her speech—on palliative care, burdensome treatment and other issues.
Many hon. Members have pointed out that we can wrestle over those matters in Committee, and obviously that is right, but it is worth outlining the concerns in detail at this stage. I want to make something clear before I do that, however. Several hon. Members talked about elderly patients receiving inadequate care in hospital. The Government are wholly opposed to poor or inadequate treatment for all patients and for elderly patients as much as anyone else, whatever their age. I reject the claim that elderly patients are routinely starved in the national health service. That does a disservice to NHS staff, many of whom make the welfare of the patients they care for their top priority. We take individual claims about inadequate treatment extremely seriously and will investigate them. We are also drawing up a national service framework for older people with the assistance of an external reference group to set out standards of care, including issues such as the nutritional needs of elderly patients and their care in the NHS.
That has nothing to do with the Bill, which is not about remedying inadequate care. It concerns deliberate decisions to withhold or withdraw treatment. As I have made clear, euthanasia is wrong and unlawful in the United Kingdom. It will remain so. Such a deliberate act cannot be justified, but the case law on the withdrawal or withholding of treatment—which have been described by many hon. Members as an omission rather than an act—is, unsurprisingly, complicated. When a patient is in hospital there is no doubt that the doctor owes the patient a duty of care. That certainly includes a requirement not to kill the patient intentionally by any means, action or omission.
However, all patients are different, so saying that a doctor has a duty of care does not tell us exactly what that doctor should do. That would depend on the needs of the patient. Under current case law, a doctor can only have a duty to offer treatment that would benefit the patient. That point is crucial. A doctor's omissions in respect of providing beneficial treatment to a patient to whom she owes a duty of care can be just as culpable—

just as unlawful—as a positive attempt to kill that patient using a toxic drug. However, under current case law, when treatment is of no benefit to a patient, a doctor has no duty to provide it. Failure to provide such treatment, even when it is of no benefit, is an omission, but it cannot be unlawful even if the patient dies of his or her illness as a result. Equally, under present law the doctor has no duty to provide a treatment that the patient refuses. If a patient is offered and refuses treatment, the doctor's omission in not providing it cannot be culpable.
The Bill proposes a radical change in the law surrounding the withholding or withdrawal of treatment—not so much in terms of the intentions described by the hon. Member for Congleton, but in terms of practical application. It would switch the focus from the rights and best interests of the patient to the purpose or one of the purposes of the doctors. If it were passed, the law would judge a situation in which treatment was withdrawn or withheld not according to the decisions, rights and interests of the patient, but according to what was in the mind of the doctors.
Present law is based firmly on the rights of the patient to consent to or refuse treatment. When the patient has not made a decision in advance, and is not capable of making decisions for himself or herself, the best interests of the patient are paramount. Competent adults have the right under common law to give or withhold consent to treatment, including the use of artificial nutrition and hydration. They have that right even if that may lead to their death. Indeed, people may exercise it to bring about their own death if they so choose. People have a right to be free from unwanted bodily interference, including medical interventions. Any exception to such a right must be very seriously justified. In particular circumstances such as those governed by the Mental Health Acts, exceptions have been made, but only after careful consideration.
The Bill suggests that the law should consider each and every purpose of the doctor to decide whether an action is unlawful. It introduces a new test of "purpose", as distinct from the existing tests based on the rights and interests of the patient or, alternatively, the criminal law concept of intention, which is applicable to, for example, the homicide laws.
The hon. Member for Congleton said that she wanted to restore the integrity of the law relating to murder, but, given that the criminal laws relating to murder and manslaughter use the concept of primary intention and gross negligence rather than the concept of purpose, it is not clear how the Bill would, in practice, fit in with those existing laws.

Mr. Leigh: Does the Minister accept that a doctor who turns off an artificial breathing apparatus does so not with the intention of ending life, but with the intention of ending a treatment that can no longer serve its purpose, namely the recovery of the patient? In those circumstances, that doctor would not be affected by the Bill.

Yvette Cooper: The interpretation of "intention" can include what someone regards as being likely to happen, and what someone can know as the likely consequences of his or her decision. I shall say more about that shortly, and attempt to answer the hon. Gentleman's question in more detail.
I wonder whether the use of the words
purpose or one of his purposes
will be workable in practical terms. A doctor can always state his main purpose in performing an action, which will be sufficient to explain what has been done and which the law can and does already judge. But how can we know whether the doctor has another purpose as well? How often can we say that we know all the purposes of the people whom we know best—not just their main purpose, but one of their other purposes, even if it is as simple as doing the washing up? Just as we can never completely know the minds of those closest to us, the law has no mechanism for finding out every purpose of the doctor. As I have said, I fear that the Bill would be unworkable in practice.
Used in this sense, "purpose" appears to carry a meaning close to that of "motive". In law, the word "intent"—a concept that the hon. Member for Congleton has tried to avoid—is currently used, rather than "purpose" or "motive"; but it is not clear what "purpose" actually means. Under the Bill, attempts could well be made to interpret it in line with the legal concept of intention.
It is important to recognise what that would mean. I shall not take up the House's time with a full account of the criminal law concept of intention, but I want to highlight one aspect. Questions of intent are determined by juries following appropriate direction by the judge. The factors that they must take into account may include the probability of the outcome, and the extent to which it was foreseen by the defendant, even if it was not the main intention behind the defendant's action. From that they may infer intent, which, in law, is very different from motive or desire.
We should consider some of the consequences of change, whether it is to "purpose" or to "intent". The hon. Member for Congleton has made it clear that she wants to leave undisturbed the current position, whereby a competent adult can refuse medical treatment, but I do not think that the Bill does that. For one thing, it makes no distinction between patients who are competent to make their own decisions and those who are not: the same arrangements would apply to all.
If a doctor knew, virtually for certain, that withholding or withdrawing treatment—even at the patient's request—would result in the patient's death, and if the current legal concept of intention were applied, the doctor could be held to have intended the patient's death. The Bill would make it unlawful for a doctor to respect a patient's rights.
Even if the term "purpose" is given a more everyday meaning, the Bill requires every one of the doctor's purposes to be considered before it is decided whether withholding treatment at the patient's request is lawful.

Mr. Ashton: Is not the purpose of the Bill deliberately to introduce confusion, and to provide a deterrent? Is it not intended to frighten doctors away from taking any specific action?

Yvette Cooper: I certainly think that its consequences would be confusing, and that there would be a good deal of reliance on its interpretation by the courts. It is important to spell out those consequences.

Sir Raymond Whitney: I am no lawyer and am deeply confused by what the Minister is saying,

as I suspect that most non-lawyers would be. She seems to be unhappy about the doctor's purpose being the mainspring of the law. The hon. Member for Bassetlaw (Mr. Ashton) has suggested that that would lead to confusion. Surely, the opposite is the case. If we had a law on the lines proposed by the Bill, the matter would be clear. If death occurred, it could be established whether that was the purpose of the doctor. It seems a straightforward issue, on which the House has the right to make a judgment. It would be easy for the courts to implement the law. The Minister's proposition is obfuscating the situation, rather than the reverse.

Yvette Cooper: As I have tried to make clear, if the doctor has a duty of care towards the patient and if treatment to which the patient has consented will be in his or her best interests and beneficial, intentionally to withhold it will fall under "purposes or intention" and be unlawful. That is the current law.

Dr. Julian Lewis: It is a simple point of logic. I thought that I heard the Minister say that, to check whether one of the doctor's purposes was the termination of life, it would be necessary to know what all his other purposes were. That is a logical fallacy and simply untrue. All we have to do is look at his purposes until we find the one we are looking for. We do not have to know all the rest. There is a logical flaw in what the hon. Lady says.

Yvette Cooper: The law says that it will be unlawful if the purpose, or one of the purposes, of the doctor is to hasten death. As soon as we find that one of the purposes was to hasten death, we have found that the doctor's decision is unlawful. That does not help us in a case where the purpose is not unlawful, or if we think it should not be unlawful.

Mr. Blunt: The intervention of my hon. Friend the Member for Wycombe (Sir R. Whitney) was clear. He said that the Bill would make the law extremely clear. The Minister is approaching the matter from a position of complete rationality, mentioning doctors trying to make sensible decisions with all the competing difficulties, but the Bill will make the law completely clear. It will turn the hon. Member for Isle of Wight (Dr. Brand) and all the other doctors who make these difficult decisions every day into murderers.

Yvette Cooper: Implementing the Bill as it stands would certainly have complicated effects, making decisions unlawful that the hon. Member for Congleton does not want to make unlawful. The doctor's main purpose may be to respect the competent patient's right to refuse treatment. The Bill means that any other purposes that the doctor may have in respecting that request should be relevant, too. That would make the lawfulness of respecting the patient's rights dependent on the mindset of the doctor, not the patient's rights in the first place. The hon. Lady has made it clear that she does not intend the Bill to have any such impact, but making acts and omissions identical and focusing on the doctor's purpose would do exactly that.
Further problems arise from the Bill. The hon. Lady has said that she has no intention of preventing appropriate palliative care, or to render unlawful what is described as the principle of double effect. In such situations, clearly,


the doctor's main purpose or intention is to relieve pain, but the Bill says that all his or her other purposes are relevant.
Therefore, a doctor might be afraid to give the treatment necessary to relieve pain for fear of a potential court case calling into question what his or her other purposes might have been. I am concerned that, as a result, the Bill may lead to inadequate palliative care to patients. The Government are committed to ensuring that terminally ill patients should receive appropriate palliative care.
Many patients who need palliative care remain perfectly competent to take their own decisions about medical treatment. They may have a clear idea about the likely prognosis of their illness, and the potential effects on their quality of life. Even if the highest quality of support is available, they may still decide that they do not want to continue with their treatment.
A patient with advanced motor neurone disease, for example, may develop disabilities that make it necessary for her to receive increasing help with the tasks of daily living, such as bathing and feeding. If the person subsequently develops pneumonia, which without treatment could be fatal, she may decide that she does not want to receive that treatment, in full knowledge of the likely consequences. If the doctor understands the patient's position and desire to hasten her own death, could it be held that the doctor's purpose, or one of the doctor's purposes, was also to hasten death? For fear of that, would the doctor feel compelled to provide treatment?
As the Bill does not distinguish between the position of those who are capable of deciding for themselves and those who are not, the Bill, once interpreted in practice, could end up undermining the principle of consent.
Not all adults are capable of giving consent to, or refusing, medical treatment. That fact does not reduce or render less important the patient's human rights, and a physical intervention on the body of that person is still a violation of that person's bodily integrity. Consequently, the justification for medical treatment or intervention on any person who cannot personally consent must be considered carefully.
If the patient has already expressed his or her views by making an advance refusal of treatment that is applicable to the circumstances, current case law requires that to be respected. The House of Lords, in 1990, made it clear that if there is no such refusal, the doctor must act in the best interests of an adult patient. That does not necessarily mean only the best medical interests of the patient, but may include considerations such as the patient's psychological health and well-being.
People have very strong and conflicting views on how a patient's best interests are to be determined. Some people argue that mere existence is a benefit to be taken into account and may supersede all other considerations; others argue that it is not. In the Tony Bland case, Lord Goff pointed out:
To presume that the incompetent person must always be subjected to what many rational and intelligent persons may decline is to downgrade the status of the incompetent person by placing a lesser value on his intrinsic worth and vitality.

Mr. Blunt: On a point of order, Mr. Deputy Speaker. I anticipate that, in a few moments, a closure motion will

be moved. When you come to consider it, will you bear in mind that neither the chairman nor the two vice-chairmen of the all-party parliamentary doctor assisted dying Bill group were fortunate enough to catch your eye?

Mr. Deputy Speaker: Order. That is not a matter to be raised now.

Yvette Cooper: In current case law, only when an intervention or medical treatment is in the best interests of the patient, taking all relevant factors into account, is it lawful to start it. Similarly, only if an on-going intervention is in the best interests of the patient is it lawful to continue it. If the treatment is not in the best interests of the patient, it is not lawful to give it; hence, the doctor can have no duty to give it.
The lack of reference in the Bill to consideration of the patient's interests means that there is a risk that doctors, to ensure that there could be no doubt about any of their purposes, may feel pressurised to provide treatment beyond the point at which it is in the patient's best interests.
The hon. Member for Congleton and others have made it clear that they do not want to stop doctors withdrawing treatment that has become burdensome to the patient. However, the Bill does not say that. Clearly, a doctor's main purpose might be to withdraw treatments that are burdensome. However, if they know for certain that life will consequently end, what could their other purpose be? The Bill as drafted asks us to judge situations not according to the burden on the patient, but according to the doctor's purpose.
The issue is of course relevant not only to adults. Sadly, children may also suffer from illnesses, such as cancer, that may bring their lives to a premature end. When a young child—too young perhaps to understand what is happening to him or her—is seriously ill, the child's parents may be faced with agonising decisions. The child should of course be involved as far as possible in the decision-making process, but, if he or she is unable to be involved, the rights and best interests of the patient should be considered. The present law is based firmly on those rights.
The parent must exercise the decision-making power for the welfare of the child, in the child's best interest. If further treatment has little chance of success and may place a great burden on the child—as with some types of chemotherapy for cancer—a parent may decide it is not in the child's best interests to undergo it. The courts can review the decision if the clinical team have doubts about the parent's choice, but they too will base their assessment on the welfare of the child.
The welfare of a child is not mentioned in the Bill which deals only with the doctor's intentions or purpose. As a result, when the child's death, although almost certain with treatment, is inevitable without it, the doctor may be held to have intended the child's death. The Bill covers only the doctor's intentions and makes no reference to the best interests of the patient.
The clinical professions recognise that the withholding or withdrawing of medical treatment is a particularly difficult and sensitive area of medical practice. That is one reason why the BMA issued guidelines in June last year.
At present, decisions on withdrawing artificial nutrition and hydration from patients in a permanent vegetative state have to be reviewed by the courts, but those are not the only circumstances in which consideration may need to be given to those issues. That is why the BMA proposed additional safeguards.
When the courts considered the very sad case of Tony Bland, they considered whether artificial nutrition and hydration was part of medical treatment and care or something entirely different. I should emphasise that where a patient is capable of taking nourishment, it must always be offered.
Deeply divided views are held on the subject. The courts considered that artificial systems for delivering nutrition form part of the medical treatment or care of the patient. There is no doubt that such artificial systems can place burdens on patients—as a result of which it is not uncommon for patients in hospital to try and pull such tubes out.
Under the current case law, if artificial nutrition and hydration is agreed not to be in the best interests of the patient, to continue with it is unlawful. The Bill would change that.
Some hon. Members who disagree with the decisions made in the Tony Bland case, will be keen to support the Bill. Others—like the Government—strongly oppose euthanasia as the intentional taking of life. Many will be keen to support the Bill as a way of reaffirming their opposition to euthanasia. I hope that I have made it clear that the Bill would go further than that and shift the focus from the best interests of the patient to the purpose of the doctor. As a result, the Bill, as drafted, is unworkable in practice. For those reasons the Government are unable to support it.

Dr. Liam Fox: The many fine speeches by hon. Members on both sides of the House have made the salient points in the debate, so I shall be brief. The House owes a debt of gratitude to my hon. Friend the Member for Congleton (Mrs. Winterton) for raising such an important subject.
I am not speaking in my capacity as shadow Secretary of State for Health, but purely in a personal capacity. I believe that no action is acceptable where the primary purpose is to kill. That is why I oppose in principle and vote against the death penalty, abortion and euthanasia.
As the hon. Member for Oxford, West and Abingdon (Dr. Harris) said, it is not simply a matter of the distress of a patient, but a fundamental question of morality and ethics. We need to distinguish between the purpose and effect of a treatment or the withdrawal of a treatment.
As a doctor, I accept the concept of double effect. I fully understand that to give a patient with terminal cancer a large dose of morphine which will make him more comfortable but shorten his life span is entirely acceptable. The purpose of the treatment is to make the patient more comfortable although the ultimate effect may be to shorten life. I do not have a moral problem with that. However, so-called mercy killing crosses the line because the purpose is to cause the death of the patient. It is part of the ratchet effect that would push us towards full involuntary euthanasia. As my hon. Friend's Bill seeks to protect us against that, it should proceed in Parliament.
I have the greatest respect for the BMA and I understand why it brought forward the guidelines, but I do not agree with them. Membership of the BMA is not compulsory for doctors in the way membership of a medical defence society is, and I hope that we are willing to make that distinction.
Most of all, there has been a confusion in the debate between ethics and morality on one side, and legality on the other. Legality is a moveable feast, whose direction is decided by the judiciary or by elected representatives. What is legal or illegal may be fluid, but basic morality is not. Because the majority say something is legal, it may be so. Because the majority say something is right does not make it so. The difference between right and wrong is not part of the democratic process, but part of a much higher order.
I hope that the Government will not use procedure or their parliamentary majority to kill the Bill. It is, literally, a vital moral argument. It crosses the party political divide and should be fully played out in the House. Our constituents will judge accordingly.

Mrs. Ann Winterton: rose in her place and claimed to move, That the Question be now put.

Question put, That the Question be now put:—

The House divided: Ayes 113, Noes 2.

Division No. 54]
[2.11 pm


AYES


Amess, David
Green, Damian


Ancram, Rt Hon Michael
Grieve, Dominic


Anderson, Donald (Swansea E)
Gummer, Rt Hon John


Atkinson, Peter (Hexham)
Hammond, Philip


Beggs, Roy
Harris, Dr Evan


Beith, Rt Hon A J
Heald, Oliver


Bell, Martin (Talton)
Heath, David (Somerton & Frome)


Bell, Stuart (Middlesbrough)
Hogg, Rt Hon Douglas


Beresford, Sir Paul
Horam, John


Bottomley, Peter (Worthing W)
Howard, Rt Hon Michael


Brazier, Julian
Howarth, Gerald (Aldershot)


Burnett, John
Hoyle, Lindsay


Burstow, Paul
Hunter, Andrew


Butler, Mrs Christine
Iddon, Dr Brian


Cable, Dr Vincent
Jenkin, Bernard


Canavan, Dennis
Jones, Helen (Warrington N)


Casale, Roger
Kaufman, Rt Hon Gerald


Chapman, Ben (Wirral S)
Kelly, Ms Ruth


Chope, Christopher
Kilfoyle, Peter


Clarke, Rt Hon Tom (Coatbridge)
King, Andy (Rugby & Kenilworth)


Collins, Tim
Lansley, Andrew


Cormack, Sir Patrick
Lawrence, Mrs Jackie


Cox, Tom
Laxton, Bob


Crausby, David
Leigh, Edward


Curtis-Thomas, Mrs Claire
Lewis, Dr Julian (New Forest E)


Darvill, Keith
Lilley, Rt Hon Peter


Davies, Quentin (Grantham)
Llwyd, Elfyn


Dawson, Hilton
Lyell, Rt Hon Sir Nicholas


Day, Stephen
McAvoy, Thomas


Dobbin, Jim
McCartney, Robert (N Down)


Donaldson, Jeffrey
McGrady, Eddie


Duncan Smith, lain
Mackinlay, Andrew


Edwards, Huw
McLoughlin, Patrick


Faber. David
McNamara, Kevin


Forth, Rt Hon Eric
McNulty, Tony


Fox, Dr Liam
MacShane, Denis


Gale, Roger
Maginnis, Ken


Galloway, George
Malins, Humfrey


Gardiner, Barry
Marsden, Gordon (Blackpool S)


Gill, Christopher
Mawhinney, Rt Hon Sir Brian


Gray, James
Morley, Elliot






Olner, Bill
Spicer, Sir Michael


Paice, James
Swayne, Desmond


Paisley, Rev Ian
Taylor, John M (Solihull)


Pickles, Eric
Taylor, Sir Teddy


Pollard, Kerry
Thompson, William


Pope, Greg
Trend, Michael


Pound, Stephen
Twigg, Derek (Hatton)


Prentice, Ms Bridget (Lewisham E)
Wardle, Charles


Randall, John
Webb, Steve


Redwood, Rt Hon John
Whitney, Sir Raymond


Roe, Mrs Marion (Broxbourne)
Widdecombe, Rt Hon Miss Ann


Ryan, Ms Joan
Williams, Mrs Betty (Conwy)


St Aubyn, Nick
Winterton, Mrs Ann (Congleton)


Sayeed, Jonathan
Winterton, Nicholas (Macclesfield)


Shepherd, Richard
Tellers for the Ayes:


Singh, Marsha
Rev. Martin Smyth and


Smith, Angela (Basildon)
Mr. Joe Benton.


NOES


Harris, Dr Evan
Tellers for the Noes:


Kirkwood, Archy
Mr. Crispin Blunt and



Mr. Joe Ashton

Question accordingly agreed to.

Question, That the Bill be now read a Second time, put accordingly and agreed to.

Bill committed to a Standing Committee, pursuant to Standing Order No. 63 (Committal of Bills).

Protection of Animals (Amendment)

Order for Second Reading read.

Mrs. Claire Curtis-Thomas: I beg to move, That the Bill be now read a Second time.
I am grateful for the opportunity to present my Bill, but saddened that I will not have more time in which to do so. My aim is to plug the very clear gap in the Protection of Animals Act 1911, the measure that protects animals from cruelty or neglect. As matters stand, animals which are the subject of cruelty or neglect proceedings can be left to suffer while the law takes its course. That cannot be right. My Bill would put right that anomaly and ensure that it is possible to act quickly where necessary in the interest of the animals. It would allow those prosecuting cases of cruelty under the 1911 Act to apply to court for a care order to protect the animals concerned. The magistrates would thus be able to grant an order to those prosecutors, allowing for the temporary care, or for the disposal, sale or slaughter of the animals.
Time does not permit me to explain the detail of the measure. The key points are that the Bill would apply only once proceedings under the 1911 Act were brought, and then only to animals kept commercially. The powers will be strictly limited and will be available only when a court takes the view that it is in the interests or welfare of the animals concerned, and that the reasonable costs incurred by those caring for the animals will be recoverable from the owners.
The measure is straightforward and has been wanted for some time by those closely involved in enforcing animal welfare legislation, including animal welfare organisations and members of the State Veterinary Service. I do not have time to outline practical examples of the way in which the Bill can be helpful, but I hope to have an opportunity to do so in Committee. The measure is sensible and provides a much needed addition to the protection of animals. I commend the Bill to the House.

Mr. James Paice: I welcome the Bill and congratulate the hon. Member for Crosby (Mrs. Curtis-Thomas) on her decision to try to amend the 1911 Act. Nothing in the measure causes me or the Opposition grave concern. It is right that animals should be properly cared for, or disposed of, while a prosecution takes place. We know that such cases can take some time.
I have one slight anxiety as to the impact of the measure on defendants who are found not guilty. Would their interests be considered? However, that matter can easily be dealt with in Committee. I wish the Bill a fair wind.

The Parliamentary Secretary to the Ministry of Agriculture, Fisheries and Food (Mr. Elliot Morley): On behalf of the Government, I congratulate my hon. Friend the Member for Crosby (Mrs. Curtis-Thomas). We welcome the Bill and the Opposition's support for it. I can reassure the hon. Member for South-East Cambridgeshire (Mr. Paice). As he knows, the courts will decide on these matters and will protect the rights of the


individuals concerned. Furthermore, the Bill includes provisions relating to the legitimate interests of individuals—for example, subsidies on animals, or any surplus from the sale of the animals being returned to the individuals concerned.
Individual rights will be protected. The measure is welcomed by the Government, by the State Veterinary Service, by local government agencies and by people who would be approved to take action in appropriate cases to protect the interests of the animals.

Mr. Eric Forth: It is a great misfortune for the hon. Member for Crosby (Mrs. Curtis-Thomas), the promoter of the Bill, that, for reasons completely beyond her control, the debate did not begin until 2.24 pm. That means that the Bill cannot possibly receive proper consideration on Second Reading today.
Although the Bill is relatively straightforward, as the hon. Lady pointed out, and would update and make more effective the provisions of the 1911 Act, even at a cursory glance, it is quite substantial. There are several clauses and some important provisions—each of which is complicated, and some of which are difficult to understand. I suspect that they may be fairly difficult to implement.
I am aware that the Bill has been welcomed by the Royal Society for the Prevention of Cruelty to Animals and that the National Farmers Union believes that it is appropriate. However, that is not necessarily enough. Simply to say that groups who have an involvement, or are interested, in the subject of a measure have given it support does not justify it. That is especially true when a Bill includes complicated and difficult provisions that bear on judicial process and on disputes as to ownership—whether of animals, property or anything else—

Mr. Kevin McNamara: Will the right hon. Gentleman give way?

Mr. Forth: Certainly.

Mr. McNamara: Will the right hon. Gentleman allow those matters to be worked out in Committee?

Mr. Forth: I am grateful to the hon. Gentleman. His interventions are always helpful in elucidating matters.

Any Bill—large or small—must surely be given proper consideration on Second Reading. The hon. Gentleman has enormous experience of the House and great respect for it; he must surely agree that six minutes is hardly adequate to get a sense of the views of the House.
The promoter of the Bill showed in her introductory speech that she had been admirably briefed, but unfortunately on this occasion we could not get the full sense of the response of the Minister and the Opposition Front-Bench spokesman. The Minister, for reasons that I can understand, was not able to give us the Government's fully developed view of the Bill, and my hon. Friend the Member for South-East Cambridgeshire (Mr. Paice) did not have time to give the Opposition's fully developed view. That arose quite simply from the fact that the previous business took so long—
It being half-past Two o'clock, the debate stood adjourned.
Debate to be resumed on Friday 19 May.

Remaining Private Members' Bill

SCOTTISH ADJACENT WATERS BOUNDARIES (AMENDMENT) BILL

Order for Second Reading read.

Hon. Members: Object.
Second Reading deferred till Friday 14 April.

BUSINESS OF THE HOUSE

Ordered,
That, at the sitting on Thursday 3rd February, not withstanding Standing Order No. 16 (Proceedings under an Act or on European Union documents), the Speaker shall—

(i) put the Questions on any Motions in the name of Mr. Secretary Straw relating to Police Grant Reports (England and Wales) not later than Four o'clock; and
(ii) put the Questions on any Motions in the name of Mr. Secretary Prescott relating to Local Government (Finance) not later than Seven o'clock.—[Mr. Jamieson.]

Local Deprivation Index

Motion made, and Question proposed, That this House do now adjourn.—[Mr. Jamieson.]

Mr. Iain Coleman: I am most grateful for the opportunity to raise the issue of the index of local deprivation in this Adjournment debate. Many hon. Members will be well acquainted with the index, but some Members may be unfamiliar with the detail. Although the niceties of the subject are immensely complicated and enmeshed in highly technical detail, the workings of the index are crucial to local authorities. It has far-reaching implications for local authority finance, and in particular the allocation by central Government and Europe of regeneration and structural funding to local councils.
I shall briefly set out the background to the current position. The index is a statistical means of assessing levels and degrees of social and economic deprivation by local authority area. Its purpose is to identify areas suffering from multiple deprivation while also recognising pockets of intense deprivation in areas of relative affluence.
Several criteria referred to as indicators are assessed, which can be statistically combined to produce an overall figure for each local authority area. Those are then used to rank authorities in order of their overall level of deprivation. The rankings provided by the index are used as the crucial basis for allocating regional and structural funds to local authorities and regeneration partnerships.
Central Government funds such as the single regeneration budget and the new deal for local communities are focused on those areas identified by the index as the most deprived and the same is true of the allocation of European funds, such as objective 2. The designation of health and education action zones also uses ILD rankings.
In the allocation of the 1999 round of SRB funding, more than 80 per cent. of the available resources was allocated to those authorities ranked in the first 65 in the index. In practice, therefore, should a local authority fail to be included in that first batch of 65 councils, its potential for receiving regeneration resources through the key central Government mechanism is strictly limited.
In early 1999, the Department of the Environment, Transport and the Regions commissioned a study by social scientists and academics based at the university of Oxford into how robust a calculation of deprivation the index was, and whether it was possible to revise and improve it to ensure that it reflected the true levels of deprivation. The possible implications of that study are the basis of the grave concern felt by many local authorities throughout the country and by Members of the House, especially those representing urban areas.
The calculations used before the current review were based on 12 indicators, including levels of employment, levels of benefit receipt, mortality information, GCSE pass rates and the quality of housing. The Oxford study has concluded that the new index should be based on 32 indicators, forming six domains. There are several new criteria, in particular centring around geographical access to services, while others, including GCSE results and the cost of living in an area, have now—regrettably,

in my judgment—been removed. There is also a very significant switch in the methodology used to calculate the index.
This is obviously a highly technical and complex matter, but the new methods of calculation would have, among other things, the effect of masking highly deprived areas that already sit uneasily alongside areas of considerable affluence. Although many London authorities would be especially harshly treated by the new proposals, many other regions would also suffer. The special interest group of metropolitan authorities outside London—SIGOMA—has made it clear in its detailed submission that it is very disappointed about the effect of the proposal and has raised concerns about the methodology and the consultation process. In particular, it has called for the complete removal of the geographical access to services domain.
Bradford, Birmingham, Leicester and a number of other metropolitan authorities have also made clear their hostility to the proposals. However, I hope that my hon. Friend the Minister will understand it if I concentrate principally on the effect that the proposals would have should they be inflicted on the capital city.
Most alarmingly, six London local authorities—Hammersmith and Fulham, Ealing, Hounslow, Kensington and Chelsea, Wandsworth and Westminster—would be dramatically disadvantaged by being pushed under the key threshold for SRB funding to which I referred earlier, while Barking and Dagenham, Brent, Camden, Greenwich, Haringey, Lambeth and Waltham Forest would all drop markedly within the proposed index and that would certainly affect their priority for future funds.
The average fall in the index would be 51 places. There were previously 13 London boroughs in the top 20 most deprived authorities in the United Kingdom; now there would only be six. My borough would be especially harshly treated. It would fall from 18th to 68th in the table. Every single ward in my borough would fall in ranking using the new criteria. There were 14 wards in the most deprived 10 per cent. of local government wards and now there would only be two. There were three wards in my borough in the most deprived 1 per cent; under the new proposal there would be none in the top 350.
As I said earlier, the technical detail of the statistical analysis of the data is staggeringly complicated, but it is quite obvious that there are serious flaws in the way that the calculations have been arrived at. Perhaps the most devastating effect on London would be caused by the new weighting given to the geographical access to services domain. It would be devastating—and I would respectfully suggest to the Minister inappropriate—because in urban areas its effect in practice would be to identify the most prosperous, and not the most deprived, areas.
If we were to apply that indicator, which we believe has proved to be especially heavily weighted, to my constituency, it would produce a bizarre and perverse effect. Easily the most affluent ward in my constituency is Palace ward. It is well known to my hon. Friend the Member for Ealing, North (Mr. Pound) because it is where Fulham palace and Fulham football club are located. In that ward, an average four-bedroomed house with a moderate-sized garden will cost a purchaser anything between £500,000 and £1 million; only 9 per cent. of households are in social housing; and only


2 per cent, of the economically active are affected by unemployment. It is not an area that one could really describe as deprived.
Yet Palace ward, which is the least deprived ward in my constituency on every other possible indicator that we might use, would, under the new indicator of geographical access to services, be ranked as the most deprived. In fact, it would be ranked as more deprived even than Broadway ward in central Hammersmith, where unemployment is more than twice the national average and more than 50 per cent. of households live in social housing. In Broadway, crime rates are high and the physical environment is blighted by chronic traffic congestion on major arterial routes. Indeed, it is on every other indicator the most deprived ward in my constituency.
The geographical access domain also appears to be in complete contravention of the criteria set out in the Government's strategy to combat deprivation. SRB round 6 guidance clearly states that more than 80 per cent. of the resources available will go to the 65 top-ranked ILD authorities. The guidance then sets out the following key objectives: first, improving employment prospects, education and skills of local people; secondly, addressing social exclusion and improving opportunities for the disadvantaged; thirdly, promoting sustainable regeneration, improving and protecting environmental infrastructures; fourthly, supporting and promoting growth of local economies; and, fifthly, reducing crime and drug abuse. There is no mention at any point of geographical access as an objective, so how can it possibly be right to use it as the key determinant of who receives more than 80 per cent. of the funding?
It is impossible to calculate why London has lost out so badly. That is why it is imperative that the full underlying data be released now, so that the Association of London Government and other interested parties can commission a full academic analysis of the study. It must surely be contrary to the Government's stated policy of open government any longer to keep those data secret from those who are seriously affected by their use. I hope that the Minister will give an assurance today that the new data will be released without further delay and procrastination on the part of the Government.
If the new index is to be the pivotal element in the allocation of billions of pounds of public money, it is essential that it can be shown to be robust, thorough and fair. Until such time as that can be demonstrated—it clearly cannot be at present—it is also essential that it is not used to allocate regeneration resources. I hope that the Minister will assure the House that there can be no question of using the new index to distribute funds this financial year.
I am bound to say that employing consultants—even ones as eminent as those who were engaged—to produce a piece of work and then to employ them to be the people responsible for the consultation exercise is, at best, a dubious practice. Surely officials at the Department of the Environment, Transport and the Regions should be responsible for that exercise. Will the Minister assure the House that the consultation exercise will be genuine, thorough and independent?
The process and the outcome of the review lack transparency for the following reasons. First, the time scales to respond were absurdly short: for example, the final technical document, which was immensely

complicated, was released without prior notification two days before Christmas, giving local authorities only three weeks to respond—an impossible timetable. Secondly, as I have said, the full underlying data have still not been released, despite repeated requests from the Association of London Government, SIGOMA and others. Thirdly, the outcome is absurdly complex: only vastly experienced trained experts could possibly begin to fathom the detail of the new index. That would appear to represent a total reversal of the policy of simplifying the process of local government funding announced by the Secretary of State for the Environment, Transport and the Regions under the standard spending assessment review.
There was much rejoicing in my constituency when the Secretary of State announced last year that Hammersmith and Fulham's bid for the new deal for communities had been successful. I am pleased to report that work has already begun. I look forward to chairing an enthusiastic and imaginative partnership to deliver regeneration to a deeply deprived area of Fulham. However, it would appear that our bid could not have been successful under the new index. I urge and plead with Ministers to take a step back before introducing the new index proposals.

The Parliamentary Under-Secretary of State for the Environment, Transport and the Regions (Mr. Keith Hill): I begin, as is usual, by congratulating my hon. Friend the Member for Hammersmith and Fulham (Mr. Coleman) on having secured a debate on the index of local deprivation. I also congratulate him on his effective speech. I am grateful for the opportunity to inform him and the rest of the House about progress on my Department's review of the index. Before doing so, I shall explain what the index is and what it is used for.
At the heart of the Government's agenda lies our determination to tackle social exclusion and poverty in this country and to provide equality of opportunity. As my hon. Friend knows, that is one of the key commitments in our manifesto. The activities that we have undertaken since May 1997 include the work spearheaded by the social exclusion unit; setting up the new deal for communities programme, which has been so successful in my hon. Friend's constituency; and launching a refocused single regeneration budget. That shows clearly that we are firmly committed to helping those communities that live in the most severely deprived parts of the country.
Ask the average person in the street where the most deprived areas of England are located, and the chances are that he will think immediately of the great conurbations of the north, the west midlands and the inner-city areas of London. In many respects, that view would be right, but it is one that is more likely to be based on general impressions or gut feelings, rather than on a technical analysis. The Government, however, must make judgments on which are the most deprived areas that are based on a technical assessment of the factors that point to an area being deprived. The main measure that we use is the index of local deprivation.
The index is a measure of relative deprivation for local authority areas in England. It combines a number of indicators that are chosen to combine a range of economic, social and housing issues in a single deprivation score for each area. It enables areas to be ranked relative to one another according to their level of


deprivation. The current index was published on 11 June 1998. It updated the 1991 index of local conditions, largely with 1996 data, and realigned it to the new local authority boundaries as they stood on 1 April 1998.
The index has been used by my Department to inform the development of policies and to target regeneration funding at the most deprived areas. It is being used increasingly outside the Department as well. For example, it is being used by the Department for Education and Employment for identifying areas for selecting area-based initiatives. Also, the social exclusion unit recognised the index as a key source of information about deprived areas in its report entitled "Bringing Britain Together: a national strategy for neighbourhood renewal".
Despite that background, there was heavy criticism of the methodology used to construct the 1998 index. Also, the data used to compile it were getting rather old, and better data for small areas were becoming available for the first time. To ensure that future policy decisions are based on the most relevant methods and the most recent information that enables smaller pockets of deprivation to be picked up, the Government decided to undertake a fundamental and independent review of the index. In December 1998, my Department commissioned the university of Oxford to carry out this work.
During the summer of 1999 there was an extensive consultation exercise about the indicators to be included in a new index. In the light of that work, and the many valuable points that were made during the consultation, it has been decided that the new index will consist of 33 ward-level indicators of deprivation. These will be organised into six key domains of deprivation: low income, employment deprivation, poor health and disability, low education and training, poor geographical access to services and poor housing.
These indicators and domains are a significant improvement on the existing index, which was largely based on district-level data, mainly from 1996. Where ward-level data were used, they came from the 1991 census. We shall now have 33 indicators that are more up to date, that relate to a smaller area level and that reflect a wider range of dimensions of deprivation than the previous selection.
The importance of obtaining and using data at small-area level to secure effective neighbourhood renewal strategies and programmes is likely to be emphasised by the social exclusion unit in its consultation document on the national strategy for neighbourhood renewal, which is to be published in March.
The 1998 index was generally considered too biased towards urban areas. That is why we have introduced a domain on geographic access to services. That will be based on four indicators, three of which concern people who depend on benefits being able to get to either a post office, a food shop or a general practitioner. The fourth indicator concerns people with children aged five to eight being able to get to a primary school.
Some of those who responded to the consultations claimed that by introducing this domain we are now biasing the index in favour of rural areas. The Government do not share that view. We acknowledge that people who live in rural areas are more likely to experience access problems, but who would disagree that

the ability to get to a post office, food shop or GP is a necessity for all poor people? Geographical access has a weighting of only 10 per cent. in the index. My hon. Friend gave a dramatic example from Palace ward in his constituency, and he singled out geographic access. However, I have no doubt that if all six domains are considered together, the findings for Palace ward will be different.
After the Oxford university review team devised an agreed set of indicators and domains of deprivation, it created a methodology for bringing together all the indicators so that we have an index that identifies the location of the most deprived areas. That is far from easy, and we had to try to address the problem that the previous method—chi squared—tended to give higher deprivation scores to areas with larger populations.
The Oxford team consulted expert opinion widely, including eminent professional statisticians who were involved in the whole review. Moreover, in addition to a large interdepartmental steering committee, the Oxford team benefited greatly from an advisory panel, which included academics, statisticians and local Government officers. The Oxford proposals on methodology were put out for full public consultation in December.
The six-week consultation period ended on 17 January and we have received more than 120 responses. The approach that has been taken is supported by the majority. My Department and the Oxford team are now analysing each response. Unfortunately, therefore, I cannot report on the outcome of the analysis today. However, I stress that we shall consider carefully all the points raised in the responses, and undertake any extra work that may be necessary before making any decisions. We aim to publish a new summary index in the spring. That will be followed by a lengthier report from Oxford university, which will appear later in the summer.
It is perhaps an obvious point, but when we change the basis on which the index is calculated, some areas will move up and others will move down the index. We acknowledge that that may be due to the changed methodology and indicators more than to changes in overall patterns of deprivation. However, that should not prevent us from striving to put in place the best possible mechanism for identifying levels of deprivation.
My. hon. Friend expressed anxiety that the draft index may disadvantage some London boroughs, including Hammersmith and Fulham, because they will appear lower in the deprivation rankings under the revised index. However, I stress that the data on which this draft index is based are still being checked. Furthermore, the rankings may change if the methodology is revised in the light of consultation. I should also point out that, in the overall measure of deprivation on the draft index, which is at district level, five of the 10 most deprived districts were London boroughs. Indeed, the worst three districts were London boroughs.
My hon. Friend and others have asked why the new index does not recognise the sheer scale of ethnic minority populations in London and elsewhere. We are confident that the 33 proposed indicators fully cover the problems that ethnic minorities face. For example, we include indicators on income support receipt, unemployment, overcrowding and poor health, all of which are disproportionately experienced by many ethnic minority groups. However, we should not overlook the sheer


diversity within the ethnic minority community, as reported by the eminent 1997 Policy Studies Institute report. We therefore believe that it is inappropriate to include a reductionist indicator, which assumes that all ethnic minority people are deprived.
Hon. Members may also have noticed that the index does not contain a crime domain. There is a lack of crime data at the small area level. However, we hope to improve those data for the next revision of the index. The social exclusion unit's policy action team 18, which deals with better information, and my colleagues in the Home Office are examining that. The Association of London Government has examined the index closely and has submitted its comments on methodology. I give the assurance that those observations will of course be considered, along with all other responses.
My Department uses the index to target regeneration funding such as the single regeneration budget and the new deal for communities on the most deprived areas. On 17 December, we launched national bidding guidance for round 6 of the SRB. My hon. Friend and other hon. Members whose constituencies cover local authority areas among the 65 most deprived, according to the existing index, will be pleased to hear that those areas are eligible to bid for funding for comprehensive schemes under round 6. That eligibility will not be affected by their ranking in the revised index.
As my hon. Friend may know, the current index was taken into account in selecting areas to be invited to bid for funding under the second round of the new deal for communities, which my right hon. Friend the Minister for Local Government and the Regions announced on 10 November. He will certainly know that Hammersmith

and Fulham is an invited area and I can confirm that, wherever it ends up on the revised index, its eligibility for the second round will not be affected. Furthermore, resources from European structural funds have been allocated for 2000–06 with reference to the 1998 index. I hope that those facts give my hon. Friend the reassurance he is looking for.
Looking to the future, funding for all regeneration programmes, including expenditure on programmes aimed at deprived areas, will be determined by the 2000 spending review, which is currently under way. Decisions have yet to be taken on how the index would be used to target resources at deprived areas and the weight to be given to deprivation scores and other relevant factors in determining funding allocations. We shall also consider the need for any transitional arrangements.
The rankings may change, but that should not prevent us from pressing on with a new index. My Department, other Departments and a range of outside bodies urgently need better information on which to target their policies and with which to address the significant problems that deprived areas face. We accept that the new index would never be perfect while we lacked small area data on some of the measures that we would like to cover. We also accept that it would not provide an absolute measure of deprivation and thus it would be important to use it sensitively and appropriately. Nevertheless, we are confident that the new index will provide us with the best possible means available at the moment for identifying the most deprived areas in England.

Question put and agreed to.

Adjourned accordingly at three minutes to Three o'clock.